Insurance Refund Request Form

Student Information

Full Name(Required)

MUID(Required)

MU Email Address(Required)

Refund Request

Select the reason for your refund request.(Required)

I have graduated and do not want insurance for the next school term.

I am a student athlete and have purchased an alternate health insurance plan arranged through the Marshall University Athletics Department.

I have transferred to a different school and no longer need IFS insurance.

I have withdrawn from classes and will be departing the United States.

I will be outside of the US AND will not be enrolled for classes during for Fall 2021 semester.

Other

Other(Required)

Please list the term and year of your graduation.(Required)

For example, Fall 2022.

Which of the following actions do you intend to take after graduation?(Required)

I plan to apply for OPT.

I plan to transfer my SEVIS record to another US school.

I plan to apply for another academic program at Marshall.

I plan to change my F-1 status to another visa status.

I plan to depart the US within the 60-day grace period.

What date do you plan to depart the US?(Required)

Please list the period of coverage you would like to be refunded.(Required)

By checking the box below, I agree to the following:(Required)

I understand the the Office of International Student Services does not process refund requests directly. I understand that by submitting this form, I am allowing the Office of International Student Services to forward my request to Insurance for Students. I understand that Insurance for Students will initiate a refund with the insurance company if I am eligible for a refund.

Student Signature(Required)

By typing my name, I confirm that I am providing my electronic signature.

Date

PLEASE READ:

If you have graduated and plan to remain in the United States during your 60-day grace period or plan to apply for OPT:

Student Information

Refund Request

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