Waiving the Student Dental Health Fee

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Waiving the Student Dental Health Fee

Please fill in the following information and then attach proof of dental insurance before emailing or faxing it. My email address is kwinnett@uab.edu and my fax number is (205) 934-3057. When faxing please put ATTN: Kelsey Winnett. If you have any other questions feel free to contact me at (205) 934-5234.

Name: ___________________________________ Date: ___________________________

Student ID (BO1#): _________________________

Phone Number: ____________________________ Email: ____________________________

School Within UAB (Dental, Optometry, Medical, Etc.): _____________________________________

Year You Started the Program: ______________

What semester(s) are you waiving for? (EX: Fall 2014, Spring 2015):_____________________________

Do you anticipate keeping your outside dental insurance while studying at UAB? __________________

Even though you are requesting waiver do you foresee the need to sign up for Student Dental Health in the future? ____________________________________

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