Randolph College - Student Medical Plan Waiver 

waiver

Welcome to Randolph College's Waiver Submission Page

The waiver deadline is 02/28/2025. 

Before you get started:

  • ▪ You will need your Student ID and Date of Birth available to complete the waiver.
  • ▪ On the following page, click the magnifying glass button to look up your record using your Student ID and Date of Birth.
  • ▪ Complete as many fields as possible. Required fields are noted in bold with a red asterisk.
  • ▪ Type your name in the Signature field and enter today's date.
  • ▪ Click submit at the end of the form to complete your waiver.

Click the button below to begin your waiver form!