Davis vision student verification form 2026

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The document is a Student Verification Form for the New York State Vision Plan, intended for dependent students aged 19 to 24. It requires certification of full-time enrollment in an accredited institution and must be submitted to Davis Vision at least 10 days before a doctor's appointment. The form includes sections for personal information, school details, and signatures, along with instructions for submission via email, fax, or mail. It also warns against fraudulent claims.

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Click ‘Get Form’ to open the davis vision student verification form in the editor.
Begin by entering the dependent student's printed last name and first name in the designated fields.
Fill in the date of birth for the dependent student to confirm their eligibility.
Indicate the name and location of the school where the dependent is enrolled, ensuring accuracy for processing.
Specify the semester start and end dates to provide a clear timeframe of enrollment.
Complete the enrollee’s printed last name, first name, and member ID number to link this form to your account.
Sign and date the form at the bottom to certify that all information provided is accurate.
Once completed, choose your preferred method to return the form: email, fax, or postal mail as specified.

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