THE UNIVERSITY OF NORTH CAROLINA
AT
CHAPEL HILL
Telephone: 919-962-7007
Fax: 919-962-4140
Email: Dennis_Press@unc.edu
CB# 1270, 440 West Franklin Street
Chapel Hill, NC 27599-1270
|
THE UNIVERSITY OF NORTH CAROLINA AT CHAPEL HILL |
||
| Office
of the Controller
Telephone: 919-962-7007 Fax: 919-962-4140 Email: Dennis_Press@unc.edu |
The
University of North Carolina at Chapel Hill
CB# 1270, 440 West Franklin Street Chapel Hill, NC 27599-1270 |
|
July 7,
1998
| To: | Deans, Directors, Department Chairs, and Business Managers |
| From: | Dennis A. Press, University Controller |
| Re: | Graduate Student Health Insurance Program Student Verification Form |
A memorandum dated June 3, 1998 regarding 'Graduate Student Health Insurance
Enrollment for 1998-99 and Other Issues' included the 'Verification of
Student Eligibility' form. The form
documents
that the graduate student acknowledges responsibility for confirming his/her
eligibility for the
health
insurance plan. The form is completed and signed by the student and retained
by the department.
A revision has been made to the 'Verification of Student Eligibility' form. In order to assure appropriate use of students' social security numbers, the verification statement that each student signs on the form has been revised. The complete verification statement is below, and the revision is in bold type.
The forms should be retained by the department as evidence that the student consented to release of the social security number (SSN). A copy of the form is usually not needed by Accounting Services. However, in those instances in which the student does not consent to the release of the SSN, a copy of the 'Verification of Student Eligibility' form should be forwarded to Jana Spaugh in Accounting Services.In completing this application for enrollment in the UNC-CH Graduate Student Health Insurance Program, I am assuming full responsibility for verifying that I have reviewed the eligibility requirements below and confirm that I meet all of the requirements necessary for eligibility. Unless I have marked out this sentence, I voluntarily give permission to UNC-CH to release my Social Security Number to the insurance carrier for its use in connection with my participation in its health insurance program.
A revised 'Verification of Student Eligibility' form is enclosed. Please share this information with those individuals in your department who administer the Graduate Student Health Insurance Program.
Thank you for your assistance.
Web address for Graduate Student
Health Insurance Program Student Verification Form
http://www.unc.edu/depts/finance/controller/graduate.htm