Health Insurance Funding Request 1819
Wake Forest University requires health insurance for all full-time enrolled students. Students may choose to ENROLL in Student Blue or request to WAIVE enrollment if they carry comparable personal health insurance meeting the criteria set by WFU. The criteria for waiver can be found at
as well as on the Student Insurance Plan website,
. Students receiving need-based financial aid who enroll because of lack of coverage or their current plan does not qualify for a waiver may request additional assistance.
Last name, First name, Middle Initial
Student's Wake Forest ID number
Do you have coverage under either of your parent's health insurance plan?
Has either parent attempted to waive the Student Blue Health Plan only to have the waiver request denied?
Explain why your parent(s) are not able to provide you with comparable health insurance coverage.
I understand that a subsequent waiver of the premium based on adequate coverage will result in the loss of health insurance funding.
Never submit passwords through Google Forms.
This form was created inside of Wake Forest University.
Terms of Service