Curry College

2015-2016 Policy Year
Spring Student Health Insurance Waiver Form For NEW Spring Students Only


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

The deadline to waive the Spring Health Insurance Plan is February 1, 2016.

Asterisk (*) denotes required field

STUDENT INFORMATION
 
first name: *
last name: *
Student ID (@ followed by 8 digits): *
date of birth: * (MM/DD/YYYY)