Forms

Weill Cornell Student Accounting has provided a fast, easy and secure way for students to submit required forms and documentation.

All active students can access the forms listed below though their LEARN account:

• Financial Responsibility Agreement
  • All registered students are required to submit this from at the start of their program. For full details, please refer to the Financial Responsibility Policy.
• 1098-T Electronic Delivery Consent
  • Students are eligible to receive their 1098-T forms electronically. By submitting this form, you are giving consent to WCM to electronically deliver your 1098-T in lieu of mailing the form to your address on file.
• 2020-2021 Health Service Annual Fee Waiver Request
• To request to waive the annual Health Services Fee for the 2020-2021 academic year ($1,418), please complete this form and include all necessary documentation. 
  
• There are specific conditions that must be met to be eligible to waive the Health Services Fee.
• If you are a current employee at Weill Cornell Medicine or NYP/Weill Cornell with employer sponsored health insurance, and anticipate remaining an employee during your enrollment as a student.
• If you are a current employee at an affiliate (MSKCC, HSS, Lincoln, other NY campuses) with employer sponsored healthcare and insurance, and anticipate remaining an employee during your enrollment as a student. 
• Or if you are employed full-time (outside WCM/NYP or affiliates) and are unable to utilize Student Health Services during normal hours of operation (Monday - Friday 8 am - 4 pm).
• Third Party Sponsor Application
  • Weill Cornell Medicine will extend credit to students who present written authorization from a third party sponsor. Please note that parents/relatives/authorized users are not considered third parties.
  • The details for payment of tuition and/or fees must be submitted on the organization or corporate letterhead.
  • WCM will not extend credit for third party payments that are contingent upon course completion or a specific grade.
  • All letters of sponsorship must include the following:
    • Student name
    • Semester(s)/Academic Year covered
    • Number of credits or course work covered
    • Dollar or percentage limit (tuition and/or fees) if applicable
    • Sponsoring company's name, billing address, contact person, e-mail address and/or telephone number
    • Financial guarantee signed by authorized company individual
• Textbook Fee Waiver (EMBA/MS Program Only)
  • Weill Cornell Medicine is providing you with the option to “opt out” and obtain on your own those textbooks, course packets, and all other course materials that are publicly available. For those items that are not publicly available, the costs for those books and course materials will continue to be included in the all-inclusive tuition amount and be provided by the program.
• Dependent Health Insurance Open Enrollment Form
• Each year you will be automatically enrolled in the Cornell Student Health Plan.  To enroll your dependents in the health coverage effective 7/1/2020, please submit this form by 7/15/2020. If you have questions regarding benefits, coverage details and costs, please see the Insurance Information page. 

• Dependent Insurance Coverage Change Request
  • If you need to update you and your dependents' insurance coverage with WCM outside of the open enrollment period, a qualifying life event is required. This means that you have a change in your situation such as marriage, birth of a child, or loss of health coverage.  
  • You MUST submit this form and any supporting documentation within 30 days of your qualifying life event. Please understand that no exceptions outside of the required deadline will be made.  For more information on coverage options, benefits and costs, please see the Insurance information page. 
• Insurance Coverage Change Request
  • If you need to update your insurance coverage with WCM outside of the open enrollment period, a qualifying life event is required. This means that you have a change in your situation such as marriage, birth of a child, or loss of health coverage. 
  • You MUST submit this form and any supporting documentation within 30 days of your qualifying life event. Please understand that no exceptions outside of the required deadline will be made.  For more information on coverage options, benefits and costs, please see the Insurance information page. 
• U.S. Social Security Number or Tax ID Number Information
  • The purpose of this form is to obtain or verify your SSN or TIN to ensure the WCM record is reflecting this information correctly. Please understand that if our office does not have a valid SSN/TIN on file for you, a 1098T form will not be issued until this form is received.
• Dental & Vision Insurance Open Enrollment Form
  • If you would like to enroll, cancel, or change your dental and vision elections, eligible students
  • Available between November 15 and December 15, each year.
  • For more information on coverage options, benefits and costs, please see the Insurance information page. 
• Dependent Dental and Vision Insurance Open Enrollment Form
  • Available November 15 – December 15 for eligible students.  
  • To enroll yourself and your dependents in Vision and Dental coverage effective 1/1/2021, please submit this form. If you have questions regarding benefits, coverage details and costs, please see the Insurance Information page.
• New Student Open Enrollment Dependent Insurance Elections
  • If you would like to enroll in dental and vision coverage, please submit this form within 30 days of your program start date
  • You will not have access to this form 30 days after your program start date. For more information on coverage options, benefits and costs, please see the Insurance information page; from that page, you will be able to access the pages for dental and vision.
• New Student Open Enrollment: Dental & Vision Coverage Form
  • To enroll yourself and your dependents in Health, Vision and Dental coverage effective the first of the month in which you start your program, please submit this form. If you have questions regarding benefits, coverage details and costs, please see the Insurance Information page. 

Please note not all the forms are available throughout the year and many are subject to approval. Student will receive email notification when these forms become available or if a submitted form has been denied or is missing information.

If your form requires you to provide official documentation, please upload your document as a PDF, jpeg, or word document.

For additional information or issues accessing these forms, please contact the Office of Student Accounting