Emerson College
STUDENT HEALTH INSURANCE PLAN

Undergraduate Student Annual Waiver Form
2018-2019 Academic Year

The Deadline to Waive is September 15, 2018 

You must enter the correct Emerson Student ID to access the form. The Emerson Student ID begins with E and is followed by 8 digits.

Asterisk (*) denotes required field

STUDENT INFORMATION

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