WORCESTER STATE UNIVERSITY
STUDENT HEALTH INSURANCE PLAN
2025-2026 ACADEMIC YEAR
ANNUAL WAIVER FORM
PLEASE NOTE: YOUR WORCESTER STUDENT ID# CONSISTS OF 7 DIGITS FOLLOWING A LEADING ZERO 0XXXXXX. IF YOU DO NOT KNOW YOUR ID#, PLEASE CONTACT LAURIE RIESER AT THE BURSAR'S OFFICE AT 508-929-8816.
TO CONTINUE THE WAIVER PROCESS, PLEASE FILL OUT THE REQUIRED FIELDS BELOW: