Insurance Waiver Appeal

If your insurance waiver has been denied and you would like to appeal the decision, please fill out and submit this form.

Please note: If you are required to have health insurance and your waiver has been denied, you will be automatically enrolled in and charged for the USF student health insurance. If your appeal is approved, the charge will be removed from your account and you will not be enrolled in the USF student health insurance plan.

Your Name:       

Student ID:        

Email adress:    

Please explain the reasons for the appeal: