Accident & Sickness Waiver Form for International Students

2020-2021 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 AUGUST 1 EACH YEAR.  Due COVID-19, the waiver deadline has been extended to August 28, for the 2020-2021 academic year.

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

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