Student Health Insurance Information Form

By submitting this form, you acknowledge and agree that the health insurance information you provide—including images or details from your insurance card—will be collected and used solely for the purpose of verifying student insurance coverage and supporting required administrative processes.
We are committed to protecting your privacy. All information you submit will be stored securely and accessed only by authorized personnel. It will not be shared, sold, or disclosed to third parties except as required by law or with your explicit consent.