Westfield State University

STUDENT HEALTH INSURANCE PLAN
2017-2018 ACADEMIC YEAR
SPRING WAIVER FORM

Please note if you are a returning student and completed a fall waiver form already; you are not required to complete the spring waiver form.  This waiver applies to New Spring Students Only.

 

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

first name:
last name:
date of birth: (MM/DD/YYYY)
student ID: