Accident & Sickness Waiver Form for International Students

2016-2017 STUDENT ACCIDENT & SICKNESS WAIVER FORM FOR INTERNATIONAL STUDENTS
Complete and return this form to:  International Student Services • 711 E. Boldt Way, SPC 41 • Appleton, WI 54911
Fax:  1‐920‐832‐7026; Email:  internationalhouse@lawrence.edu

Students that have comparable insurance coverage and choose to waive the medical insurance policy offered through Lawrence University must complete this form.  If you do not have comparable insurance coverage, you will be automatically billed by the school and covered.

I have the following comparable coverage that will remain in effect throughout the academic year:

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