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DEPVERFinancial Aid Office 711 E Bold Way Appleton, WI 54911 PHONE: (920) 8326583 | FAX: (920) 8326582 financial.aid@lawrence.edu20212022 VERIFICATION FORM STUDENT NAMELAWRENCE ID ORD. O.B. Read the
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Independence Blue Cross is a health insurance provider.
Employees who have Independence Blue Cross coverage may be required to file.
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The purpose of Independence Blue Cross forms is to report health insurance coverage.
Information such as the policy holder's name, policy number, and coverage dates must be reported.
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