Fairleigh Dickinson University
STUDENT HEALTH INSURANCE PLAN

Annual Waiver Form
2024-2025 Academic Year

You may waive coverage under this plan if you have health insurance that meets Fairleigh Dickinson University’s insurance plan requirements. You will need to provide information about your other coverage.  

The waiver deadline is September 30, 2024.

PLEASE FILL OUT THE REQUIRED FIELDS BELOW: