Insurance Waiver Petition

* = required field

Waiver Petition

I do not wish to purchase the Drury University International Student Health Plan for 2014-15. 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:

Waiver Petition Acknowledgement

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 2014-15.


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 (submit this online)


  4. A copy of financial guarantee letter (or scholarship letter) for SACM students (and Kuwait students)


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 medical coverage.