Simmons University

Graduate Student Health Insurance Plan 
Annual Waiver Form 
August 15, 2019 - August 14, 2020


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

Please note if you just registered for classes you will have to wait a week to complete the form. Simmons University updates the authorization list for access to the forms once a week.

 (MM/DD/YYYY)