Fac-Staff - COVID 19 Vaccination Self-Certification

COVID 19 Vaccination Self-Certification

In the interest of maintaining the health and safety of students, employees, guest and all members of our campus community, the California State University is requiring that faculty, staff and students who are on campus accessing campus facilities at any University location to be immunized against SARS-CoV-2, the virus that causes COVID-19. 

Students or employees may seek an exemption based on medical or religious grounds. This requirement is effective immediately, with certification required no later than September 30, 2021.

For additional information, please review the COVID-19 Vaccination Interim Policy.

In this article we will be showing you how to submit and edit your COVID-19 Vaccination Self-Certification.


1.      Open your Web-browser and go to my.fresnostate.edu then click Sign In.

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2.      Once you have logged in please click on Employee Self Service tile.

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3.      After clicking on the Employee Self Service tile please click on the COVID19 Self-Certification option on the left hand side.

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4.      You will now see the form below. This is the Covid-19 Vaccination Self Certification form that must be filled out no later than September 30, 2021.

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5.      Please select one of the four option located in Section I.

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·         In this example we will be selecting the “I have received the approved vaccination” option.

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Fill this out to the best of your ability.  Note: You must fill in both doses for the vaccine if you have not received the Johnson& Johnson vaccination.

6.      Click the box in Section II to Certify that the information you have provided is correct.

7.      If in Section I you selected the “ I have received the approved vaccination” you must attach a copy of your COVID-19 Vaccination Record Card in Section III.


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8.      When the form has been completed, click the “Submit” button.

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9.      Once you have clicked the “Submit” button you should see the confirmation below.

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For addition information regarding  the COVID-19 Vaccination Self-Certification, please contact the Student Health and Counseling Center at 559.278.2734



Article ID: 136793
Thu 8/12/21 1:01 PM
Thu 8/12/21 1:21 PM