NICHOLS COLLEGE
STUDENT HEALTH INSURANCE PLAN

2017-2018 Academic Year

Spring Term Waiver Form

(For New Students for Spring Term Only)


TO CONTINUE THE WAIVER PROCESS, PLEASE FILL OUT THE REQUIRED FIELDS BELOW.  PLEASE NOTE YOU WILL NEED TO USE YOUR NICHOLS COLLEGE EMAIL ADDRESS IN THE FOLLOWING FORMAT:  firstname.lastname@nichols.edu

first name:
last name:
date of birth: (MM/DD/YYYY)
email address: