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George Washington University
STUDENT HEALTH INSURANCE PLAN

Annual Waiver Form
2025-2026 Academic Year

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

The waiver deadline is September 12, 2025.

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

Asterisk (*) denotes required field

 (MM/DD/YYYY)