Request_to_Add_Insurance_Premium_to_Budget by xusuqin


									                                                                                                 Office of Financial Aid

              Request To Add Insurance Premium To Cost Of Attendance Budget
                                   Fall 2009 – Spring 2010

All full-time undergraduate and graduate students are required to participate in a mandatory health
insurance program, sponsored by the university, unless they currently have adequate health insurance
from another vendor. Students, who will be required to participate in the university health insurance
program, can request that the cost of the insurance premium be included in their financial aid budget.
If you would like to have this cost added to your budget, please complete this form and return it to the
Financial Aid Office.

I certify that I will be required to participate in Western Carolina University’s health insurance policy
and I request that the amount of the yearly premium be added to my cost of attendance budget.

Even though I request that my budget be increased, I understand that this may not result in an increase
in the amount of financial aid I am eligible to receive and that the only potential source of aid will be

If I receive an increase in financial aid and do not participate in the insurance program, I understand
that the increase in aid will be cancelled and that I will owe that money back to the university.

Name:     ________________________________________                        Student Id #: ____________________

Address: ________________________________________



Signature: ________________________________________                     Date: ________________________

                                                                                                           Financial Aid Office
                                118 Killian Annex │Cullowhee, NC 28723│(828) 227-7290 tel │(828) 227-7042 fax│

To top