Exemption from the student accident and sickness insurance plan must be on file
no later than the 8th day of the semester/term
. I understand that if this waiver is not on file prior to this date, I will be charged for student insurance if I am a Residential Student, a Student Athlete, and/or a F-1 International Student.
By submitting this form, I have read the above statements. I am, also, requesting exemption from payment of the charge for the student accident and sickness insurance plan.
I understand that I willl not be covered by the student accident and sickness insurance plan. I, also, understand that the University will not be expected to bear any medical costs incurred by me.
This waiver is good for ONE Academic Year (August-July)
. I understand that I must submit a NEW waiver every Fall semester to continue to be exempt from student insurance charges. The waiver must be submitted within the first 8 days of the semester/term.