Required for Registration
RELEASE OF INFORMATION
This is not a mandatory form. Just complete if you need one of the following:
- You seek care at Curry Health Center and need previous health records sent to Curry Health Center.
- You want Curry Health Center to send your health records to another location.
A change in a student's initial insurance selection requires a manual adjustment to the student's account. That transaction requires the student's signature.
The student must print and complete the appropriate form. Once completed, the student can upload the form, as well as documentation if required (International Students), to the Health Portal utilizing the instructions below.
Instructions to upload completed forms to the Health Portal:
- Log into your account on Health Portal (you will need your Cyberbear credentials)
- Click on "Uploads"
- Scroll to bottom to chose document you are uploading
- Select "Insurance Documentation"
- Select file to upload
- Upload completed form
- Send an email from your UM student email account (please, include your 790#) to the Student Insurance Representative at firstname.lastname@example.org informing the upload has been done.
Because of the large volume of requests received, and the time it takes to process each one, you will only be notified, via your student email account, if more information needed. If what is received is adequate, the charge will be credited back to your student account.
Please, print and complete the form. Upload the completed form, along with the accompanying official documentation that is listed on the form. Your documentation will be reviewed.
Please, allow 3-5 business days for processing.
**If your tuition bill does not reflect a T101/T102 BCBSMT Insurance charge, you were not charged for the Student Health Insurance Plan. Therefore, you do not need to submit a form.**
Please make sure you have the coverage that fits your needs.
Please complete and upload this form if you are a Montana Medicaid participant.
Please, allow 2-3 business days for processing.
Once the form has been reviewed and/or processed, you will be contacted by Student Insurance representative via your UM student email with the determination.
CLASS EXCUSE: COVID-19
Please use the following form if your instructor requires an excuse from class and you are experiencing COVID-19 symptoms and must miss class:
Feedback Form: WE WANT TO HEAR FROM YOU!
We pride ourselves on serving students and we want to know if we're doing it well.
This form is anonymous to preserve your confidentiality. If you want to have someone follow up personally with you after you submit your form, please call (406) 243-6076 and Laura Davy will have the appropriate staff member follow up with you.