Emerson College
STUDENT HEALTH INSURANCE PLAN

Graduate Student Spring 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 coerage prior to the appropirate deadline each academic year. Failure to do so will result in the student being charged for the SHIP

The waiver deadline if February 1, 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)