NEW ENGLAND COLLEGE OF OPTOMETRY
STUDENT HEALTH INSURANCE PLAN

annual Waiver Form

2017-2018 Academic Year

Eligible students who have other health insurance coverage and do not wish to be enrolled in the SHIP must submit an online waiver documenting their other coverage prior to the appropriate deadline each academic year. Failure to do so will result in the student being charged for and enrolled in the SHIP.

The waiver deadline is February 15, 2018.

Asterisk (*) denotes required field

STUDENT INFORMATION

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