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Thomas Jefferson University
STUDENT HEALTH INSURANCE PLAN

Summer/Pre-Fall Waiver Form 
2023-2024 Academic Year

The summer/pre-fall waiver form is available to NEW summer or NEWLY eligible students only. Students who missed the annual or spring waiver deadline are not permitted to waive summer. 

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

Please note, your Jefferson Campus Key is a combination of 3 digits and 3 letters.

Asterisk (*) denotes required field

 (MM/DD/YYYY)