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Ithaca College
STUDENT HEALTH INSURANCE PLAN

2024-2025 POLICY YEAR
Spring Waiver Form


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.

Asterisk (*) denotes required field