suny brockport logo

Health Insurance Waiver Notification Form

Before submitting this form, you must apply for AND be approved for a health insurance waiver.

To apply for a health insurance waiver:

1. Follow the instructions found at this link:
https://hfcsews.my.site.com/StudentPortal/s/?accountCovId=a00Us00000MZARQ&schoolId=001Us000009JRSL

2. If approved, you will be notified via email.

3. Upload a copy of the approval email in this form below.