Insurance waiver for International StudentsCleveland State 2025

1. Click ‘Get Form’ to open it in the editor.
2. Begin by selecting the term for which you are appealing: Fall, Spring, or Summer. Fill in the year accordingly.
3. Provide your personal information in the Student Information section, including your last name, first name, middle name, date of birth, US phone number, and email address.
4. Enter details about your insurance company, including its name, US phone number, and email address.
5. In the Current Insurance Information section, fill out the address of your insurance company and provide your insured’s name along with relevant policy details such as group number, policy number, ID number, effective date, and expiration date.
6. Indicate the reason for denial as stated in your notification email from AIG. Check all that apply.
7. Print your name and sign at the bottom of the form. Include the date of signing.

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