Olin College of Engineering
Student Health Insurance Waiver Form

2018-2019 Policy Period
August 15, 2018 to August 14, 2019


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: