Late Insurance Waiver Request Form

The late waiver request is only for students who have a valid reason for missing the 30 day normal waiver period. For example, you were outside the United States, you were hospitalized, you did not enroll in your thesis or co-op until after the 30 day period, etc.

To continue the late waiver process, please fill out the required fields below:

I certify that the coverage under this health plan is comparable to coverage under the RIT student health insurance program and I understand I am responsible for my medical expenses once this waiver is submitted. I also certify that my insurance coverage will remain in effect without restrictions providing coverage during the current academic year. The submission of this waiver form including all information herewith constitutes truthful and accurate statements.