Required for New Students
- Immunization Verification Form:
- This form is expected to be submitted by the first week of class.
-May submit by e-mail in .pdf format to email@example.com; you will receive a confirmation e-mail with further instruction, if necessary.
Insurance and Other Forms (Waiver and Enrollment forms may be found under the insurance tab)
- Medical Record Release Form: To release or obtain a copy of your immunization records and/or any medical records, please complete this form and mail or fax it to us. We will mail or fax your records within 7-14 business days of receiving the completed form and payment.
- Insurance Enrollment or Waiver Form: All students who want to enroll or waive the student health insurance plan need to fill out this form. This link will also allow you to enroll dependants. (Not ALL forms of health insurance are accepted)
If you are a part-time student and would like to enroll in the student health insurance plan, please send an email to firstname.lastname@example.org. Your email should include your date of birth and student ID number.
- Fall Only Health Insurance Form: All students who are graduating or leaving the university and would no longer like the Student Health Insurance coverage for the Spring semester should complete this form.
- Prescription Drug Claim Form: Students needing to submit a claim for a prescription to the Insurance Company should fill out this form and mail it along with the pharmacy receipt to the address on the form.