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: 970-351-4726

Our office is located in:
Cassidy Hall
1901 10th Avenue
(SW corner of 10th Ave. & 19th St.)

NOTE: The online waiver for Fall 2016 - 2017 is closed.

Instructions for Accessing the Online Waiver Form:

  1. If you already have an URSA account, you may log into, click on the Student tab and locate the link to the "Online Health Insurance Waiver". Scroll down to the "Begin" button.
  2. IMPORTANT: Please be sure to have your insurance card available before you enter the online waiver system!

  3. If you have been admitted, but do not have an URSA account, access the URSA home page at 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.

2015-2016 Plan Year Documents


NOTE: Please contact Cece Clark in the Student Health Insurance Office at 970-351-1915 for information on premium and dates of coverage.