Olin College of Engineering
Student Health Insurance Waiver Form

Spring 2018 Policy Period
January 15, 2018 to August 14, 2018


In order to successfully complete the waiver form please provide your 8 digit Olin Student ID number (the S is not required).  New Students, your 8-digit Student ID number was provided to you by the Admissions Office.

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

 

first name:
last name:
date of birth: (MM/DD/YYYY)
student ID: