Westminster Theological Seminary

The Philadelphia campus offers a full range of doctoral, masters, and certificate programs.

PHILADELPHIA

The London program offers a Masters in Theology degree.

LONDON

Welcome to Westminster!

Application Process

Application Checklist

Forms for Admission

Application Deadlines

Tuition and Special Fees

Insurance Forms

Waiver

view as pdf

STUDENT HEALTH INSURANCE WAIVER FORM
2008-2009

For FULL-TIME STUDENTS who are NOT participating in the Westminster-sponsored health insurance plan: You must complete and return this form (ALONG WITH a copy of the front of your insurance card or letter from your insurance company) to the Student Affairs office by Friday, Sept 5th (first week of classes).

SECTION 1:

STUDENT INFORMATION

* Last Name
* First Name
US Social Security Number
Email

Address1
Address2
State
Zip Code
Country
Phone

I understand that I must have health insurance to be enrolled as a full-time student at Westminster
Theological Seminary. I will not be joining the Seminary’s sponsored student insurance plan
because I have comparable coverage through the following group or private policy:

INSURANCE COMPANY

POLICY #

I fully understand that I am legally responsible for any medical expenses. I promise to maintain
my health insurance coverage while a full-time student or, if my medical insurance protection is
terminated, I promise to enroll in another health insurance plan and submit a waiver form to
the Student Affairs office within 3 weeks (21 days) of said termination.
I understand that this waiver is only valid when accompanied by 1) a copy of the front of my
insurance card or 2) a signed letter from my insurance company. I have provided this.
I further understand that this waiver is effective through September 1, 2009 and must be renewed
at the start of each academic year.

SECTION 2 (to be signed by J-1 and F-1 VISA students only):

Int’l student on J-1 or F-1 VISA?

Yes No

I have Medical Evacuation and Repatriation of Remains (MERR) coverage as evidenced by the
copy of my policy, which I am submitting along with this form.