Curry College

2014-2015 Policy Year
Student Health Insurance Waiver Form for NEW Summer Students


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

The deadline to waive the Health Insurance Plan for NEW Summer Students is July 17, 2015.

Asterisk (*) denotes required field

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