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UNIVERSITY OF MASSACHUSETTS - LOWELL
STUDENT HEALTH INSURANCE PLAN

Spring Waiver Appeal Form
2023-2024 Academic Year

 

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

THE WAIVER APPEAL DEADLINE IS MARCH 29, 2024.

Asterisk (*) denotes required field

STUDENT INFORMATION

 
 (MM/DD/YYYY)