Gordon-Conwell Theological Seminary
STUDENT HEALTH PLAN

2018 - 2019 Waiver Form

Spring Term 2019

New incoming Spring 2019 students taking 6+ credits at both South Hamilton and Boston who will have adequate health insurance from January 15, 2019 through August 31, 2019, can submit this waiver form to opt out of the Student Health Plan.

If you do not complete this waiver form by midnight on February 1, 2019, you will be charged for the Student Health Plan. 


This form is for New Incoming Spring 2019 students who are eligible
for the Student Health Plan.


TO CONTINUE THE WAIVER PROCESS, PLEASE FILL OUT THE REQUIRED FIELDS BELOW.  Please note that it is very important that you enter your Student ID correctly; failure to do so may result in your waiver not being processed, and the insurance charge being added to your tuition bill:

Asterisk (*) denotes required field

STUDENT INFORMATION

 
first name: *
last name: *
student ID: *
date of birth: * (MM/DD/YYYY)