Curry College

2015-2016 Policy Year
Annual Student Health Insurance Waiver Form


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

The deadline to waive the Annual Health Insurance Plan is September 15, 2015.

Asterisk (*) denotes required field

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