Curry College

2018-2019 Policy Year
Annual Health Insurance Waiver Form


TO CONTINUE THE WAIVER PROCESS, PLEASE FILL OUT THE REQUIRED FIELDS BELOW:

The deadline to waive the Annual Health Insurance Plan is September 14, 2018.

Asterisk (*) denotes required field

STUDENT INFORMATION

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