Accident & Sickness Waiver Form for International Students

2019-2020 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.  THE WAIVER DEADLINE IS JULY 1 EACH YEAR.

The waiver request for the 2019-2020 academic year is now closed.  Please direct any questions to Wellness Services.  The waiver request will re-open in Spring Term 2020.

I have the following comparable coverage that will remain in effect throughout the waiver period indicated:

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