These forms may be downloaded and printed.
Note, you will need to have Adobe Acrobat Reader installed on your computer to access these forms.
Our fax number is: 970-351-3234
Our office is located in:
1901 10th Avenue
(SW corner of 10th Ave. & 19th St.)
NOTE: The Fall Semester 2014 waiver is available online through your URSA account after May 11, 2014. The waiver deadline for Fall Semester 2014 is September 8, 2014 at 8:00pm.
Instructions for Accessing the Online Waiver Form:
- If you already have an URSA account, you may log into http://ursa.unco.edu, click on the Financial tab and locate the link to the "UNC Student Health Insurance Plan Online Waiver System" (SHIP). Scroll down to the "Begin" button.
- If you have been admitted, but do not have an URSA account, access the URSA home page at http://ursa.unco.edu and create your student account from the link titled "NEW STUDENTS START HERE." Once your account has been established, follow the same steps as in item 1 above.
IMPORTANT: Please be sure to have your insurance card available before you enter the online waiver system!
2013-2014 Plan Year Documents
- Health Insurance Booklet - 2013 -2014
- Dependent Enrollment Form - 2013-2014
- Re-enrollment Form - 2013-2014
- Sports Rider Enrollmnent Form - 2013-2014
- Temporary ID Card 2013-2014 Contact Cece Clark at 351-1915
2012-2013 Plan Year Documents
- Health Insurance Booklet - 2012-2013
- Dependent Enrollment Form - 2012-2013
- Re-enrollment Form - 2012-2013
- Sports Rider Enrollment Form - 2012-2013
- Temporary ID Card - 2012-2013 - Contact Cece Clark at 351-1915.
2011-2012 Plan Year Documents
- Health Insurance Booklet - 2011-2012
- Dependent Enrollment Form - 2011-2012
- Re-enrollment Form - 2011-2012
- Sports Rider Enrollment Form - 2011-2012
- Temporary ID Card - 2011-2012
2010-2011 Plan Year Documents
- Health Insurance Booklet - 2010-2011
- Dependent Enrollment Form - 2010-2011
- Re-enrollment Form - 2010-2011
- Sports Rider Enrollment Form - 2010-2011
- Temporary ID Card - 2010-2011
NOTE: Please contact Cece Clark in the Student Health Insurance Office at 970-351-1915 for information on premium and dates of coverage.