Complete this form ONLY if you have Proof of Alternate Health Insurance.
Students who have other coverage and are waiving out of the Student Health Insurance Plan MUST complete the online Waiver Form by the due date.
The Waiver must be completed by: 01/14/2022. The opportunity to waive coverage is limited ONLY to students who have other health insurance.
Required items are indicated with an asterisk (*). You MUST click the Submit Button to complete the form.