maincurve Home MyUC iLearn Webmail
title Student Insurance

UNIVERSITY OF THE CUMBERLANDS
2014-2015 VOLUNTARY ACCEPTANCE OF STUDENT INSURANCE

 

Student Information

Student's First Name
Student's Middle Name
Student's Last Name
/ /
Student's Birthdate
Student ID #
Student's SSN (Internationals use UC ID)
Student's Address - This is where your Insurance ID Card will be mailed
City
State
Zip
Email Address
Primary Phone Number
Secondary Phone Number

Please select the intercollegiate sports the student is participating in at UC.
Please check all that apply:
Men's Sports














Women's Sports













Coed Sports



Verification and Submission

I  request to be added to UC's student insurance program for the 2014 Fall term. I understand that my voluntary enrollment in this program is subject to the eligibility requirements of the insurance company, and if approved to be insured, a premium charge of $525 will be charged to my Cumberlands' student tuition account. The signature of a parent or guardian is required if the student is under age 18.

 

Student Signature
Parent Signature (if applicable)
Date


UC News Calendar Give to UC Apply to UC Contact Us YouTube Twitter Facebook