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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. Deadlines: 

Fall 2018 - August 17; Spring 2019 - January 11; Summer 2019 - May 17.

STUDENT'S PERSONAL INFORMATION

Please fill out the student's information.

REASON FOR WAIVER REQUEST
HEALTH INSURANCE INFORMATION

Please upload copy of your health insurance card (front and back). Your file cannot exceed 8 megabytes (MB).

If you are sponsored student, upload your Scholarship Letter here. Your file cannot exceed 8 megabytes (MB).

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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