Important Forms to Fill Out
Please read each section carefully, as specific instructions to submit the different forms are provided.
|1. Housing Placement, Residence Hall Agreement and New Student Survey Form||Due by June 21.
Return via email to firstname.lastname@example.org or by snail mail to Pitzer College.
|2. Orientation Adventure Trip Preference Form||Registration begins June 10.
Follow the online submission instructions.
|3. Medical Insurance Information||Available beginning July 1|
|4. Entrance Personal History/Medical Examination Report Form AND Monsour Counseling First-Year Survey Form||Due August 1, 2013
Must be submitted directly to CUC Student Health Services.
1. Housing Placement, Residence Hall Agreement and New Student Survey Form
As a first-year student you will be placed with a roommate in Pitzer, Atherton or Sanborn residence hall, Pitzer’s first-year complex. Housing placement and roommate matches are made based on the answers provided in the Housing Placement form. You will also need to fill out and sign the Pitzer College Residence Hall Agreement. This form is in PDF format and may be filled out and saved to your computer.
Here are a couple of solutions to some common problems that students sometimes encounter with the PDF form:
1. Do NOT fill out the form while it is opened in your browser. SAVE AS to your desktop as a separate file, then fill it out and save it.
2. If you are using a MAC, do NOT use Preview to fill out the form. Use Acrobat Reader (the PDF software which is free and can be downloaded online here), and make sure to “save as .pdf” when you save your document.
• Housing Placement, Residence Hall Agreement and First-Year Student Survey Form - due June 21.
You may choose to submit a hard copy by mail or email completed forms to email@example.com.
Below is an example of how the form will appear in your browser. Select the "Save a copy" icon.
For a list of suggested items to bring with you in the fall, click here.
2. Orientation Adventure Preference Form
All incoming students who are not New Resource Students, exchange students or transfer students are required to go on an OA trip as part of their broader orientation to Pitzer College. New Resource Students and transfer students are encouraged to sign up, but are not obligated to do so. At this time, an Orientation Adventure trip is not an option for exchange students.
Orientation Adventure Trip Preference Form
Follow the submission directions online. Orientation Adventure registration begins June 10, 2013.
3. Medical Insurance Information – All students
Medical insurance is mandatory for all students. All students will be automatically enrolled in the Claremont Colleges’ Student Health Insurance Plan unless they complete the online waiver information HERE. In order to access the portal, you will have to enter your last name, date of birth and student ID number. Please note that all incoming freshman will receive an e-mail the week of July 8th with instructions on how to access their ID number.
In order to qualify for a waiver, students must have other insurance coverage, and benefits under that plan must include all of the following:
• Coverage must be continuous (no break or termination) for the entire academic year;
• Coverage must be effective prior to 8/25/2013;
• Maximum lifetime benefit must be at least $500,000;
• Deductible must be $1,000 or less per policy year;
• Claims must be paid by a U.S.-based company; and
• Underwriting company must be owned, operated, and headquartered in the United States and must be in full compliance with applicable federal laws. International students may not waive with insurance from their home country.
The portal will be open from July 2, 2013 to September 6, 2013. If you do not enter your health insurance information, you will automatically be enrolled in the Claremont Colleges Student Health Insurance and your student account will be billed accordingly.
For frequently asked questions and more information
Student Health Insurance Plan (SHIP) 2013-14 Brochure
Student Health Insurance Plan (SHIP) Waiver.
If you have any questions or concerns, please contact the Office of Student Affairs 909.607.2821 or e-mail firstname.lastname@example.org
4. Student Health Services – All new students
Your Entrance Personal Health History/Medical Examination Report Form is filled out and submitted directly to Claremont University Consortium (CUC) Student Health Services. Please review all the information thoroughly before submitting the completed form to CUC Student Health Services. You may choose to submit your completed form by mail or email to email@example.com
Please take a moment to visit the Student Health Services website here http://www.cuc.claremont.edu/shs/forms.asp, as it contains important information such as the entrance physical forms, psychiatric medication policy, and vaccine information. Although the Student Health Center is closed for the summer, you may access additional information regarding Student Health Services by visiting their web page at www.cuc.claremont.edu/shs or call Student Health Services and leave a voice mail message at (909) 621-8222 which is checked weekly.
To access all of the the Student Health Services forms online, click here.