Elms College
Health Insurance Waiver Form

Annual Term 2018

All Returning and New Incoming Students for Fall Term 2018

The waiver deadline date has been extended to August 31, 2018
 


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

Asterisk (*) denotes required field

STUDENT INFORMATION

 
first name: *
last name: *
social security number: *
student ID: *