NICHOLS COLLEGE
STUDENT HEALTH INSURANCE PLAN

2018-2019 Academic Year

Annual Term Waiver Form

For all New and Returning Students for Fall Term 2018


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: