ENDICOTT COLLEGE
STUDENT HEALTH INSURANCE PLAN

GRADUATE ANNUAL WAIVER APPEAL FORM
2020-2021 POLICY PERIOD

VAN LOAN SCHOOL OF GRADUATE AND PROFESSIONAL STUDIES

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 deadline to complete the waiver form is August 3, 2020. 

Asterisk (*) denotes required field

STUDENT INFORMATION

 
 (MM/DD/YYYY)