George Washington University
STUDENT HEALTH INSURANCE PLAN

Spring Waiver Appeal Form 
2022-2023 Academic Year

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

The waiver appeal deadline is April 30, 2023.

Please note, your George Washington student ID# begins with a "G" followed by 8 digits.

 (MM/DD/YYYY)