Identification of Insurance for College or University and Authorization 2026

1. Click ‘Get Form’ to open it in the editor.
2. Begin by selecting your status as a New Student or Returning Student, and indicate the semester you are enrolling in.
3. Fill in your personal details including your name, student identification number, date of birth, and contact information.
4. Provide information about your father or guardian, including their name, address, phone number, and social security number.
5. Enter your medical insurance details. Specify the company or plan name, address, policy number, and whether it is an HMO or PPO.
6. Indicate if pre-authorization is required for treatment and if a second opinion is needed before surgery.
7. Repeat the previous step for your mother’s insurance information if applicable.
8. In the authorization section, grant permission for treatment by signing and dating where indicated. Ensure that all necessary signatures are obtained from parents or guardians if under 19 years old.

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