Health Insurance Form Waiver
** This form is required for all Northland College students for the WINTER 2013-2014 Academic Year **
Each year, Northland requires all full-time students to either choose the college-sponsored health insurance plan through WPS or provide proof of private health insurance. This form is designed to assist students and their families in making a health insurance choice that best suits their needs. This form must be completed and submitted by August 1, 2013 or you will be automatically enrolled in the college-sponsored plan.
If you answer no to any of the questions within the waiver form, you will be automatically enrolled in the Northland College insurance plan. You must answer yes to all in order to opt-out.
**Do not fill out this form if you wish to accept the 2013-2014 Northland College health insurance for $1,489.20.**
1411 Ellis Avenue Ashland, WI 54806-3999
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