Brandeis University
STUDENT HEALTH INSURANCE PLAN

​Annual Waiver Form
2015-2016 Academic Year

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

You must use your Brandeis email to access the form. Your Brandeis email (UNet Account) is your official email address. Brandeis will begin using it immediately for all official communications. If you do not have a Brandeis email address, please follow the instructions below.

For New Students: To create a new Brandeis email account (UNet Account), please visit Library and Technology Services website, click on "Create an official staff/faculty/student account', and follow the instructions.  You will need to have the SAGE (Student Administration Gateway) ID number provided to you by your Admissions Center.
 

first name:
last name:
date of birth: (MM/DD/YYYY)
email address: