2013-14 Academic Year
I do not wish to purchase the Drury University International Student
Health Plan for 2013-14. In submitting this insurance Waiver Petition
form, I fully understand that it is my responsibility to maintain health
insurance for myself and my family (if applicable).
Answer YES or NO to each of the following statements
about your health insurance plan:
Please check all that apply:
By submitting this insurance Waiver Petition form, I am agreeing
that I do not wish to purchase the Drury University International Student
Health Plan for 2013-14.
I understand that in order to complete the waiver process for a review, three things must be submitted to the International Student Office two weeks before the official start date of class:
1. A photocopy of my insurance card (front and back)
2. A copy of the declarations page (listing the benefits) from my current insurance policy
3. A completed insurance waiver petition
I understand that failure to complete this within the deadline will mean I will automatically be charged the current fees for the Drury insurance coverage offered through Seven Corners.
Finally, I understand that granting this Waiver is in the sole
and final discretion of Drury University. If the Waiver is granted,
I agree release Drury University from any liability for any issue of
If you do agree to the above statement, please select
the "I Agree" button and you should receive an online verification
that your application has been received.