Request Form for Spring 2012
Please be advised that NIU will verify the information you enter onto this form.
You will receive a confirmation via your NIU email account within 7 business
days of the acceptance or denial of your waiver request.
If your waiver request is denied, you may submit additional information to the
student insurance office for reconsideration.
International students on F1 or J1 visas are not eligible to complete this form.
Please contact the student insurance office at 815-753-0122 or email
email@example.com for more information or if you have any
If you have problems with your log-in, please contact the ITS helpdesk at
Validation of your current coverage by a third party is
Enter your login information and click
'Submit' to continue.