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Providence College
STUDENT HEALTH INSURANCE PLAN

Annual Waiver Form
2024-2025 Academic Year

TO CONTINUE THE WAIVER PROCESS, PLEASE FILL OUT THE REQUIRED FIELDS BELOW:

You must use your Banner ID#. Your Banner ID# is your identification number for the College and is a 9-digit #
You must use your Providence email address to access the waiver form.

Asterisk (*) denotes required field