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 2022-23 Academic Year UC SHIP Waiver Application forms will be available as of June 1st, 2022.
You are encouraged to use the online waiver portal to submit your waiver application for the upcoming 2022-23 academic year.