The forms on this page are for the current academic year. Please be sure to complete the appropriate form, and attach all required documentation (if applicable) before submitting it to the Insurance Services department. Incomplete forms will not be processed.

Forms can be submitted via email or fax.

Contact information for the Insurance Services department:

Email: insurance@shcs.ucdavis.edu

Fax: (530) 752-7679 

UC SHIP Waiver Application - Paper Form

These forms are only to be used if the online waiver system is unavailable. Paper waiver applications can take up to 30 days to be processed.

Please attach a copy of your current insurance ID card (both front and back), a copy of your insurance plans summary of benefits, and documentation from your insurance company, dated within the last 30 days, that shows you are currently covered. 
Documentation can be in the form of: 

  • a letter
  • an email
  • a screenshot of your insurance company's website showing your coverage is currently active 

Failure to include the appropriate documentation will result in your waiver application not being processed.

The 2023-24 Academic Year UC SHIP Waiver Application form is now available.


UC SHIP Forms - Other

Please fill out the appropriate form completely, and attach all required documentation, before submitting it to the Insurance Services office. 

UC SHIP Waiver Appeal form - This form is to be used if your waiver application was denied and you are no longer able to access the online waiver site to make corrections or upload additional documentation.

UC SHIP Waiver Cancellation form - This form is to be used if you have an approved waiver on file for the current academic year, but you wish to cancel it and enroll in UC SHIP.

UC SHIP Cancellation and Refund Request form - This form is to be used if you are no longer a UC Davis student (withdrawn, cancelled registration, dismissed, PELP, Filing Fee), and do not wish to be enrolled in UC SHIP for the current term. 

UC SHIP Late Waiver form -  If you have missed the waiver deadline, you can submit a waiver application form, and indicate on the form why you missed the deadline. The waiver application must be submitted with all of the required documentation. Approved late waiver forms are subject to a $50 administrative fee.