Curry College

2016-2017 Policy Year
Adult Term II Student 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 November 2, 2016.

Asterisk (*) denotes required field

STUDENT INFORMATION
 
first name: *
last name: *
Student ID (@ followed by 8 digits): *
date of birth: * (MM/DD/YYYY)