AHP Waiver System

Welcome to Purdue NorthWest - Undergraduates

Purdue University

Student Registration Form

F1 and J1 International Students Only

Waiver Account Creation

This form will create your waiver system account which can be used again in subsequent semesters. Completing this form will NOT submit a waiver request.

Student information

First Name*

Student ID*

Middle Name

Birth Date (MM DD YYYY)*

Last Name*

Gender*

Address

City

State

Zip

Contact Information

School Email*

Personal Email

Parent/Alternate Email

Student Phone*

Your waiver submission has NOT been completed

Select the 'REGISTER' button below to go to the Student Dashboard. Next select the WAIVE button under the "I Already Have Insurance." section. Then you will be able to enter your waiver information and submit your waiver request.

Set Your Password

Password *
Confirm Password

Sign up for Waiver Status messages. You will receive a text message whenever there is a status change on your waiver submission(s).

Signup for Texts:
Mobile Number * :

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