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Health Insurance Waiver Form

Please fill out the form below completely, and submit it along with the required documents to the Office of International Student and Scholar Services (OISSS) before the deadline. Incomplete waiver applications will be rejected. Do not wait for the deadline!  Your application will be reviewed within 5-7 business days of submission. 

Health Insurance Waiver Form

STUDENT'S INFORMATION

Please fill out the student's information.

WAIVER AND INSURANCE INFORMATION

Please upload copy of your health insurance card (front and back).

If you are sponsored student, upload your Scholarship Letter here. 

By submitting this form, I certify that I have ready all of the waiver requirements, policy, and procedures listed on OISSS website and on this waiver request form and agree to abide by them.  By agreeing and submitting this form, I acknowledge that the information above is true and accurate and I understand that I must carry health insurance as long as I am enrolled at EKU. 

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