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ITHACA COLLEGE Student Health Insurance Plan Qualifying Event Enrollment Form STUDENT INFORMATION: (ALL fields are required) Student Name: (Last)___ (First)___ (MI)___ Student ID#: ___ Gender: ___Date
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How to fill out waive or enroll in

01
Obtain a copy of the waiver or enrollment form from the organization or institution.
02
Read the instructions carefully to understand what information is required.
03
Fill out the form accurately and completely, providing all the necessary personal details.
04
Double-check the form for any errors or missing information before submitting it.
05
Submit the completed form to the appropriate department or individual within the specified deadline.

Who needs waive or enroll in?

01
Anyone who is required to provide proof of insurance coverage or permission to participate in an activity may need to fill out a waiver or enroll in a program.
02
This could include students participating in school sports, individuals attending a fitness class, or participants in a recreational event.
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Waive or enroll in refers to the process of choosing whether or not to participate in a certain program or service.
Individuals who are eligible for the program or service are required to file a waive or enroll in form.
To fill out a waive or enroll in form, you need to provide personal information and make the decision to either waive or enroll in the program.
The purpose of waive or enroll in is to give individuals the choice to participate or not in a specific program or service.
Information such as personal details, reasons for waiving or enrolling, and any relevant documentation may need to be reported on a waive or enroll in form.
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