George Washington University
STUDENT HEALTH INSURANCE PLAN

Annual Waiver Appeal Form
2023-2024 Academic Year

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

The waiver appeal deadline is November 30, 2023.

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

 (MM/DD/YYYY)