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Ithaca College
STUDENT HEALTH INSURANCE PLAN

2023-2024 POLICY YEAR
Spring Waiver Form


This form is only for NEW INCOMING Spring 2024 Students. If you were enrolled for Fall 2023 and need to waive Spring 2024 coverage, please select the Spring Opt-Out Request Form link on the left-hand side of this page. 

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

Please Note: You must enter your Ithaca College email address below. Entering your personal email address will not allow you access to the waiver form. You must activate your Ithaca College Netpass/e-mail account prior to completing this process.