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Insurance Waiver Petition

* = required field

Waiver Petition

I do not wish to purchase the Drury University International Student Health Plan for 2016-17. 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:

What is the contact information for your insurance company?

Waiver Petition Acknowledgement