Summer Health Insurance Waiver

Request Deadline: March 15th for upcoming summer.

Name Name First Last
Banner ID
Email
I am covered by my national or private health insurance during the summer.
Departure date from US Departure date from US / MM / DD YYYY
Return date to the US Return date to the US / MM / DD YYYY
Please upload a copy of your travel itinerary. (Canadian students may enter their plans in the comments section.)
maximum 5 files whose total size may not be more than 10MB
filenames should not contain more than one period (.)
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