These forms may be downloaded and printed on your printer for completion.
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 2013 waiver is available online through your URSA account. The waiver deadline for Fall Semester 2013 is September 9, 2013 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.