Get Student Signature: Date: - Student Insurance - Shbp Mines

Completing the Student Signature: Date: - Student Insurance - Shbp Mines form online is essential for students who are required to provide proof of health insurance. This guide will walk you through the necessary steps to accurately fill out this important document.

Follow the steps to successfully complete your insurance waiver form.

1. Press the ‘Get Form’ button to acquire the document and open it in your chosen editor.
2. Fill in the required student information section. Provide your CWID, last name, first name, middle initial, birth date, and your current address including city, state, and zip code. Include your phone number with the area code and your Mines email address.
3. Indicate your status by circling the appropriate option for your enrollment type: Domestic Undergraduate, Domestic Graduate, International Undergraduate, or International Graduate.
4. In Section 2, express your request to waive the SHBP by confirming that your health insurance meets the outlined requirements. Initial each applicable statement regarding coverage to ensure compliance.
5. Provide the name of your insurance company, policy/group number, and the phone number for verifying coverage. If applicable, include the name of your employer providing coverage and claims address.
6. Carefully read the attestation statement confirming that the information provided is accurate. This statement also indicates your understanding of the consequences of falsification.
7. Sign and date the form in the designated areas. Note that if you are under 18, a parent or guardian must also sign.
8. Once completed, save any changes made to the document. You may also choose to download, print, or share the form as needed.

Ensure your health insurance waiver form is complete and submit documents online to meet your health insurance requirements.