I do not wish to purchase the Franklin University International Student
Health Insurance Plan for 2012-2013. In submitting this Insurance Waiver Petition,
I fully understand that it is my responsibility to maintain health insurance
for myself and my family (if applicable).
Please answer the following questions to determine if your current coverage
exempts you from purchasing the school's recommended insurance coverage.
The Harbour Group
66 Remick Blvd.
Springboro, OH 45066
I understand that authorizing this Insurance Waiver Petition is in the
sole and final discretion of Franklin University. If the Waiver is
authorized, I release Franklin University from any liability for any issue
of medical coverage.
I confirm that I have read and accept all of the provisions of the plan, as stated in this document.