Westminster Theological Seminary

The Philadelphia campus offers a full range of doctoral, masters, and certificate programs.

PHILADELPHIA

The London program offers a Masters in Theology degree.

LONDON

Welcome to Westminster!

Application Process

Application Checklist

Forms for Admission

Application Deadlines

Tuition and Special Fees

Insurance Forms

Insurance Sign Up

view as pdf

STUDENT HEALTH INSURANCE SIGN-UP FORM
2008-2009

For all FULL-TIME students who do NOT have alternative health insurance coverage:

You must enroll in the Westminster-sponsored Health Insurance plan by Friday, Sept 5th (first week of classes). After you have done this, you must complete and return this form (ALONG WITH a copy of the front of your insurance card or your Health Insurance Enrollment form) to the Student Affairs Office.

SECTION 1: STUDENT INFORMATION

* Last Name
* First Name
US Social Security Number

Address1
Address2
State
Zip Code
Country
Telephone
Email

I understand that I must have health insurance to be enrolled as a full-time student at Westminster Theological Seminary and have enrolled in Westminster’s sponsored student insurance plan. I promise to maintain my coverage while a full-time student or, if I decide to cancel my policy, I promise to enroll in another health insurance plan, and submit a waiver form to the Student Affairs office within 3 weeks (21 days) of said cancellation. I understand that this sign-up is only valid when accompanied by a copy of my enrollment form. I have provided this. I further understand that this waiver is effective through September 1, 2009 and must be renewed at the start of each academic year.

SECTION 2 (to be signed by J-1 and F-1 VISA students only):

Are you an international student on J-1 or F-1 VISA?

Yes No

If yes,

I have Medical Evacuation and Repatriation of Remains (MERR) coverage as evidenced by the copy of my policy, which I am submitting along with this form.