Background: Coronavirus disease 2019 is an infectious disease caused by severe acute respiratory syndrome coronavirus 2 which is responsible for the worst pandemic today. Currently, there are strong efforts that made the COVID-19 vaccine available in Ethiopia to control the spread of the virus. But little is known about the adult population’s acceptance of COVID-19 vaccination in Bahir Dar city, Amhara region, Ethiopia. Objective: To assess adults’ COVID-19 vaccination acceptance levels and associated factors in Bahir Dar City Administration, North West Ethiopia, 2022. Methods: A community-based cross-sectional study was conducted among adults at Bahir Dar city, Amhara region, from March 8th -30th, 2022. A multistage sampling technique was used to select 788 respondents. Face-to-face interviews were used to collect the data, which were entered into Epi-data and exported into SPSS for analysis. Descriptive statistics were computed and presented by tables, graphs, and texts. Bivariable logistic regression analysis was computed to identify variables for multivariable analysis. Multivariable logistic regression analysis was computed to identify statistically significant variables by considering p<0.05. Results: From 788 samples, a total of 728 adults participated in this study with a response rate of 92.4%. The acceptance rate of COVID-19 vaccination was 62.0% (95% CI: 58.3%, 65.5%). The factors significantly associated with vaccine acceptance were educational status of grade 9-12 [AOR=2.67, 95% CI: (1.14, 6.27)] and completed higher education [AOR=3.05, 95% CI: (1.49, 6.24)], occupation of daily laborers [AOR=2.09, 95% CI: (1.06, 4.13)], living with a person at risk of severe COVID-19 disease [AOR = 3.12, 95% CI: (1.98, 4.91)], high perceived susceptibility of Covid-19 [AOR = 2.02, 95% CI: (1.26, 3.24)], high perceived severity of COVID-19 [AOR = 3.39, 95% CI: (2.12, 5.41)], good knowledge on COVID-19 disease [AOR = 2.85, 95% CI: (1.68, 4.83)], good practice on COVID-19 prevention [AOR =3.10, 95% CI: (1.46, 6.59), and good knowledge on COVID-19 vaccine [AOR =2.47, 95% CI: (1.16, 5.27)]. Conclusion: The current study found that two out of every three individuals are willing to receive COVID-19 vaccination. Educational status, occupational status, knowledge and preventive practice toward COVID-19 disease, knowledge of its vaccine, and perceptions of the disease susceptibility and severity affect the acceptance of COVID-19 vaccination. This implies that multiple efforts are still needed to improve the COVID-19 vaccine's acceptability. Keywords: Acceptance, COVID-19, vaccine, vaccination, associated