Gordon-Conwell Theological Seminary
STUDENT HEALTH PLAN

Spring 2015 Waiver Form

New and newly eligible spring students taking 6+ credits who will have adequate health insurance from January 15, 2015, through August 31, 2015, can submit this waiver form to opt out of the Student Health Plan.

If you do not complete this waiver form by midnight on February 6, 2015, you will be charged for the Student Health Plan on your student account.

If you do not complete this waiver form by the FINAL DEADLINE of midnight on February 20, 2015, you will be unable to remove the charge on your student account.


If you were registered for 6+ credits inSouth Hamilton (or 9+ credits in Boston) for the Fall 2014 semester and already completed a Waiver Form this academic year, you do not need to submit a new form for Spring 2015.


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

Asterisk (*) denotes required field

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