Get Western Illinois University Student Claim Form

Filling out the Western Illinois University Student Claim Form online is a straightforward process. This guide will help you navigate each section of the form to ensure you provide all necessary information accurately and efficiently.

Follow the steps to complete your student claim form online.

1. Press the ‘Get Form’ button to access the Student Claim Form and open it for editing.
2. Enter your name and student ID number clearly in the designated fields.
3. Provide your address in the specified area to maintain accurate contact information.
4. Indicate when your symptoms first appeared or when the accident occurred by filling in the appropriate date.
5. Enter the date of the medical emergency in the corresponding field.
6. Describe the injury or sickness you are claiming by writing a detailed account in the provided section.
7. If applicable, explain how and where the accident took place, ensuring to give as much detail as possible.
8. Answer whether the injury occurred while working by checking the appropriate box.
9. If the injury happened during a sports activity, select the type of sport involved from the options listed.
10. Provide the name and address of the doctor you consulted regarding this claim.
11. Indicate whether you have other insurance coverage by selecting either 'Yes' or 'No'.
12. Ensure to collect and attach all itemized bills related to your claim as this is required.
13. Sign and date the form at the bottom, confirming your authorization for the release of your medical information.
14. Once the form is complete, save the changes, and proceed to download, print, or share the document as necessary.

Complete your student claim form online today to ensure you receive the support you need.