Health Insurance Waiver


Health Insurance coverage is conditional for all full time students. You may waive the Health Insurance Fee by completing and signing the waiver form.

WAIVER FORMS MUST BE IN THE STUDENT ACCOUNTS OFFICE NO LATER THAN THE END OF THE SECOND WEEK OF THE SEMESTER!

This form does not apply to Foreign Health Insurance.
International students, students in overseas programs, and scholars must contact:
Center for International programs (845) 257-3125

Name (please print): _______________________

Student ID#: _______________________

Name of Insurance Co: _______________________

Type of Insurance (check one):
_____Family
_____ Individual

I certify the insurance outlined herewith will be in force for the entire academic year and that I do not want to participate in the Student Accident and Health Insurance Plan. I will be personally responsible for the payment of all medical expenses incurred by me or required by the college.