Important Forms to Fill Out - Transfer Students Only
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 December 19 at 5 p.m. Pacific Standard Time.
Return via email to email@example.com or by snail mail to Pitzer College.
|2. Medical Insurance Information||Due by December 19 to Pitzer College|
|3. Entrance Personal History/Medical Examination Report Form||Due January 13, 2014.
Must be submitted directly to CUC Student Health Services.
1. Housing Placement, Residence Hall Agreement and New Student Survey Form
All transfer students admitted in the Spring 2014 semester are offered housing in in Mead hall, Atherton hall, and Phase II in double occupancy rooms. While Pitzer, Atherton, and Sanborn hall is our first year complex, the fourth floor of Atherton houses upperclassmen. Atherton Hall and Phase II have double occupancy rooms with two rooms sharing an adjoining vanity, bathroom, and shower. Mead hall suite-style living has a common room equipped with couches and side tables. Each suite houses eight students (four students in single rooms and four students in double rooms) with two bathrooms in each suite.
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.
These forms are due by December 20. DO NOT FILL OUT THESE FORMS IN YOUR BROWSER. Save this writable PDF form to your computer, fill it out, save the file, then attach it in an email. Please double-check your form before you email it to make sure the information is saved.
• Housing Placement, Residence Hall Agreement and First-Year Student Survey Form - due by December 19.
You may choose to submit a hard copy by mail or email completed forms to firstname.lastname@example.org.
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 click here.
2. 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 December 11, 2013 to January 16, 2014. 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
Student Health Insurance Portal
If you have any questions or concerns, please contact the Office of Student Affairs 909.607.2821 or e-mail email@example.com
3. 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 firstname.lastname@example.org
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.