FITCHBURG STATE UNIVERSITY
Student Health Insurance Program
2024-2025 Policy Year
Fall Term Waiver Form
TO CONTINUE THE WAIVER PROCESS, PLEASE FILL OUT THE REQUIRED FIELDS BELOW:
PLEASE NOTE: You must enter your Student ID number below, with the "@" symbol in front, in order to proceed (Example: @XXXXXXXX). Entering your social security number will not allow you access to the waiver form.