Waiving the Student Dental Health Fee



Download 2.51 Kb.
Date conversion26.11.2016
Size2.51 Kb.
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? ____________________________________


The database is protected by copyright ©dentisty.org 2016
send message

    Main page