{"id":44954,"date":"2026-08-12T09:57:06","date_gmt":"2026-08-12T13:57:06","guid":{"rendered":"https:\/\/carleton.ca\/go-isso\/?page_id=44954"},"modified":"2026-08-12T09:57:07","modified_gmt":"2026-08-12T13:57:07","slug":"uhip-opt-out-form","status":"publish","type":"page","link":"https:\/\/carleton.ca\/go-isso\/uhip-opt-out-form\/","title":{"rendered":"UHIP Opt-Out Form"},"content":{"rendered":"\n<section class=\"w-screen px-6 cu-section cu-section--white ml-offset-center md:px-8 lg:px-14\">\n    <div class=\"space-y-6 cu-max-w-child-5xl  md:space-y-10 cu-prose-first-last\">\n\n            <div class=\"cu-textmedia flex flex-col lg:flex-row mx-auto gap-6 md:gap-10 my-6 md:my-12 first:mt-0 max-w-5xl\">\n        <div class=\"justify-start cu-textmedia-content cu-prose-first-last\" style=\"flex: 0 0 100%;\">\n            <header class=\"font-light prose-xl cu-pageheader md:prose-2xl cu-component-updated cu-prose-first-last\">\n                                    <h1 class=\"cu-prose-first-last font-semibold !mt-2 mb-4 md:mb-6 relative after:absolute after:h-px after:bottom-0 after:bg-cu-red after:left-px text-3xl md:text-4xl lg:text-5xl lg:leading-[3.5rem] pb-5 after:w-10 text-cu-black-700 not-prose\">\n                        UHIP Opt-Out Form\n                    <\/h1>\n                \n                                \n                            <\/header>\n\n                    <\/div>\n\n            <\/div>\n\n    <\/div>\n<\/section>\n\n\n<script>\nvar gform;gform||(document.addEventListener(\"gform_main_scripts_loaded\",function(){gform.scriptsLoaded=!0}),document.addEventListener(\"gform\/theme\/scripts_loaded\",function(){gform.themeScriptsLoaded=!0}),window.addEventListener(\"DOMContentLoaded\",function(){gform.domLoaded=!0}),gform={domLoaded:!1,scriptsLoaded:!1,themeScriptsLoaded:!1,isFormEditor:()=>\"function\"==typeof 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var(--gf-field-img-choice-check-ind-icon-size-md);--gf-field-pg-steps-number-color: rgba(17, 35, 55, 0.8);}<\/style>\n                        <div class='gform_heading'>\n                            <h2 class=\"gform_title\">University Health Insurance Plan (UHIP) Opt-Out Form<\/h2>\n                            <p class='gform_description'>The following form is to be completed ONLY by students residing outside of Canada. Students with questions about their UHIP coverage should contact the Global Opportunities &#8211; International Student Services Office (GO-ISSO) at isso@carleton.ca<\/p>\n\t\t\t\t\t\t\t<p class='gform_required_legend'>&quot;<span class=\"gfield_required gfield_required_asterisk\">*<\/span>&quot; indicates required fields<\/p>\n                        <\/div><form class='not-prose' method='post' enctype='multipart\/form-data'  id='gform_287'  action='\/go-isso\/wp-json\/wp\/v2\/pages\/44954' data-formid='287' novalidate>\n                        <div class='gform-body gform_body'><div id='gform_fields_287' class='gform_fields top_label form_sublabel_below description_below validation_below'><fieldset id=\"field_287_1\" class=\"gfield gfield--type-name gfield--input-type-name gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' ><span class='gform-field-label__text'>Name<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/legend><div class='ginput_complex ginput_container ginput_container--name no_prefix has_first_name no_middle_name has_last_name no_suffix gf_name_has_2 ginput_container_name gform-grid-row' id='input_287_1'>\n                            \n                            <span id='input_287_1_3_container' class='name_first gform-grid-col gform-grid-col--size-auto' >\n                                                    <input type='text' name='input_1.3' id='input_287_1_3' value=''   aria-required='true'     \/>\n                                                    <label for='input_287_1_3' class='gform-field-label gform-field-label--type-sub '>First<\/label>\n                                                <\/span>\n                            \n                            <span id='input_287_1_6_container' class='name_last gform-grid-col gform-grid-col--size-auto' >\n                                                    <input type='text' name='input_1.6' id='input_287_1_6' value=''   aria-required='true'     \/>\n                                                    <label for='input_287_1_6' class='gform-field-label gform-field-label--type-sub '>Last<\/label>\n                                                <\/span>\n                            \n                        <\/div><\/fieldset><div id=\"field_287_2\" class=\"gfield gfield--type-number gfield--input-type-number gfield_contains_required field_sublabel_below gfield--has-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_287_2'><span class='gform-field-label__text'>Carleton Student ID Number<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_number'><input name='input_2' id='input_287_2' type='number' step='any' min='100000000' max='999999999' value='' class='medium'     aria-required=\"true\" aria-invalid=\"false\" aria-describedby=\"gfield_instruction_287_2 gfield_description_287_2\" \/><div class='gfield_description instruction ' id='gfield_instruction_287_2'>Please enter a number from <strong>100000000<\/strong> to <strong>999999999<\/strong>.<\/div><\/div><div class='gfield_description' id='gfield_description_287_2'>9 Digit Student ID Number<\/div><\/div><fieldset id=\"field_287_7\" class=\"gfield gfield--type-email gfield--input-type-email gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' ><span class='gform-field-label__text'>Carleton Email<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/legend><div class='ginput_complex ginput_container ginput_container_email gform-grid-row' id='input_287_7_container'>\n                                <span id='input_287_7_1_container' class='ginput_left gform-grid-col gform-grid-col--size-auto'>\n                                    <input class='' type='email' name='input_7' id='input_287_7' value=''    aria-required=\"true\" aria-invalid=\"false\"  \/>\n                                    <label for='input_287_7' class='gform-field-label gform-field-label--type-sub '>Enter Email<\/label>\n                                <\/span>\n                                <span id='input_287_7_2_container' class='ginput_right gform-grid-col gform-grid-col--size-auto'>\n                                    <input class='' type='email' name='input_7_2' id='input_287_7_2' value=''    aria-required=\"true\" aria-invalid=\"false\"  \/>\n                                    <label for='input_287_7_2' class='gform-field-label gform-field-label--type-sub '>Confirm Email<\/label>\n                                <\/span>\n                                <div class='gf_clear gf_clear_complex'><\/div>\n                            <\/div><\/fieldset><fieldset id=\"field_287_4\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible gfield--choice-align-vertical\"  ><legend class='gfield_label gform-field-label' ><span class='gform-field-label__text'>Where are you residing during the Fall 2026 Term at Carleton University?<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_287_4'>\n\t\t\t<div class='gchoice gchoice_287_4_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_4' type='radio' value='Inside Canada'  id='choice_287_4_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_287_4_0' id='label_287_4_0' class='gform-field-label gform-field-label--type-inline'>Inside Canada<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_287_4_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_4' type='radio' value='Outside of Canada'  id='choice_287_4_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_287_4_1' id='label_287_4_1' class='gform-field-label gform-field-label--type-inline'>Outside of Canada<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_287_23\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible gfield--choice-align-vertical\"  ><legend class='gfield_label gform-field-label' ><span class='gform-field-label__text'>Where are you residing during the Winter 2027 term at Carleton University?<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_287_23'>\n\t\t\t<div class='gchoice gchoice_287_23_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_23' type='radio' value='Inside Canada'  id='choice_287_23_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_287_23_0' id='label_287_23_0' class='gform-field-label gform-field-label--type-inline'>Inside Canada<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_287_23_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_23' type='radio' value='Outside of Canada'  id='choice_287_23_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_287_23_1' id='label_287_23_1' class='gform-field-label gform-field-label--type-inline'>Outside of Canada<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_287_35\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible gfield--choice-align-vertical\"  ><legend class='gfield_label gform-field-label' ><span class='gform-field-label__text'>Where are you residing during the Summer 2027 term at Carleton University?<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_287_35'>\n\t\t\t<div class='gchoice gchoice_287_35_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_35' type='radio' value='Inside Canada'  id='choice_287_35_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_287_35_0' id='label_287_35_0' class='gform-field-label gform-field-label--type-inline'>Inside Canada<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_287_35_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_35' type='radio' value='Outside of Canada'  id='choice_287_35_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_287_35_1' id='label_287_35_1' class='gform-field-label gform-field-label--type-inline'>Outside of Canada<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_287_8\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible gfield--choice-align-vertical\"  ><legend class='gfield_label gform-field-label' ><span class='gform-field-label__text'>If you are residing outside Canada, do you have an anticipated date of arrival to Canada?<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_287_8'>\n\t\t\t<div class='gchoice gchoice_287_8_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_8' type='radio' value='Yes'  id='choice_287_8_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_287_8_0' id='label_287_8_0' class='gform-field-label gform-field-label--type-inline'>Yes<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_287_8_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_8' type='radio' value='No'  id='choice_287_8_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_287_8_1' id='label_287_8_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_287_25\" class=\"gfield gfield--type-date gfield--input-type-date gfield--input-type-datepicker gfield--datepicker-default-icon gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_287_25'><span class='gform-field-label__text'>What is your anticipated date of arrival in Canada?<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_date'>\n\t\t\t\t\t<input\n\t\t\t\t\tplaceholder='mm\/dd\/yyyy'\n\t\t\t\t\tid='input_287_25'\n\t\t\t\t\tclass='datepicker gform-datepicker mdy datepicker_with_icon gdatepicker_with_icon'\n\t\t\t\t\ttype='text'\n\t\t\t\t\tname='input_25'\n\t\t\t\t\tvalue=''\n\t\t\t\t\t \n\t\t\t\t\taria-invalid=\"false\" \n\t\t\t\t\taria-required=\"true\"\n\t\t\t\t\t \n\t\t\t\t\t\n\t\t\t\t\t\/>\n\t\t\t\t<kbd id='keyboardHint_input_287_25' hidden class='down'><\/kbd>\n\t\t\t\t<button type='button' id='datepicker_toggle_input_287_25' class='gform-datepicker-toggle gform-datepicker-toggle--default accCalendar aria-date-picker gform-button gform-theme-button gform-theme-button--simple gform-theme-button--simple-in-ctrl' aria-expanded='false' aria-controls='input_287_25' aria-label='What is your anticipated date of arrival in Canada?: Choose date on calendar' >\n\t\t\t\t\t\t\t<span class=\"gform-calendar-icon gform-datepicker-toggle-icon gform-datepicker-toggle-icon--default dashicons dashicons-calendar-alt\" aria-hidden=\"true\"><\/span>\n\t\t\t\t\t\t<\/button>\n\t\t\t<\/div><\/div><fieldset id=\"field_287_10\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible gfield--choice-align-vertical\"  ><legend class='gfield_label gform-field-label' ><span class='gform-field-label__text'>Do you have family members who will be accompanying you to Canada for your studies (spouse and\/or children)?<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_287_10'>\n\t\t\t<div class='gchoice gchoice_287_10_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_10' type='radio' value='Yes'  id='choice_287_10_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_287_10_0' id='label_287_10_0' class='gform-field-label gform-field-label--type-inline'>Yes<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_287_10_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_10' type='radio' value='No'  id='choice_287_10_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_287_10_1' id='label_287_10_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_287_31\" class=\"gfield gfield--type-html gfield--input-type-html gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  >Dependents must be <a href=\"https:\/\/carleton.ca\/go-isso\/uhip\/uhip-for-students\/#enrolment\">enrolled separately<\/a> within the University Health Insurance Plan.  Please note, that you must request to re-enroll your dependents in UHIP each academic year. \n\nQuestions? Contact the ISSO at isso@carleton.ca<\/div><div id=\"field_287_20\" class=\"gfield gfield--type-textarea gfield--input-type-textarea field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_287_20'><span class='gform-field-label__text'>Any additional comments?<\/span><\/label><div class='ginput_container ginput_container_textarea'><textarea name='input_20' id='input_287_20' class='textarea medium'      aria-invalid=\"false\"   rows='10' cols='50'><\/textarea><\/div><\/div><fieldset id=\"field_287_14\" class=\"gfield gfield--type-checkbox gfield--type-choice gfield--input-type-checkbox gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible gfield--choice-align-vertical\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' ><span class='gform-field-label__text'>By clicking this box, I hereby certify that I will be residing and studying outside of Canada for either the entire Fall 2026, Winter 2027, or Summer 2027 (or all) and I am therefore opting out of coverage for that period.<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/legend><div class='ginput_container ginput_container_checkbox'><div class='gfield_checkbox ' id='input_287_14'><div class='gchoice gchoice_287_14_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_14.1' type='checkbox'  value='Confirmed'  id='choice_287_14_1'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_287_14_1' id='label_287_14_1' class='gform-field-label gform-field-label--type-inline'>Confirmed<\/label>\n\t\t\t\t\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_287_15\" class=\"gfield gfield--type-checkbox gfield--type-choice gfield--input-type-checkbox gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible gfield--choice-align-vertical\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' ><span class='gform-field-label__text'>I acknowledge and agree that it is my responsibility to notify the ISSO before I plan on travelling to Canada in order to reinstate my coverage. Once opted out of coverage I understand and agree that I will only be reinstated once I notify the ISSO in writing that I am travelling to Canada.<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/legend><div class='ginput_container ginput_container_checkbox'><div class='gfield_checkbox ' id='input_287_15'><div class='gchoice gchoice_287_15_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_15.1' type='checkbox'  value='Confirmed'  id='choice_287_15_1'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_287_15_1' id='label_287_15_1' class='gform-field-label gform-field-label--type-inline'>Confirmed<\/label>\n\t\t\t\t\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_287_32\" class=\"gfield gfield--type-checkbox gfield--type-choice gfield--input-type-checkbox gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible gfield--choice-align-vertical\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' ><span class='gform-field-label__text'>I acknowledge that enrolment in the University Health Insurance Plan (UHIP) is mandatory for eligible international students, and their dependents, when they come to Canada.<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/legend><div class='ginput_container ginput_container_checkbox'><div class='gfield_checkbox ' id='input_287_32'><div class='gchoice gchoice_287_32_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_32.1' type='checkbox'  value='Confirmed'  id='choice_287_32_1'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_287_32_1' id='label_287_32_1' class='gform-field-label gform-field-label--type-inline'>Confirmed<\/label>\n\t\t\t\t\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_287_16\" class=\"gfield gfield--type-checkbox gfield--type-choice gfield--input-type-checkbox gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible gfield--choice-align-vertical\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' ><span class='gform-field-label__text'>I acknowledge and agree that UHIP fees are determined by Cowan and that reinstating coverage will result in premiums being charged to my Carleton student account.<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/legend><div class='ginput_container ginput_container_checkbox'><div class='gfield_checkbox ' id='input_287_16'><div class='gchoice gchoice_287_16_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_16.1' type='checkbox'  value='Confirmed'  id='choice_287_16_1'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_287_16_1' id='label_287_16_1' class='gform-field-label gform-field-label--type-inline'>Confirmed<\/label>\n\t\t\t\t\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_287_17\" class=\"gfield gfield--type-checkbox gfield--type-choice gfield--input-type-checkbox gfield_contains_required field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible gfield--choice-align-vertical\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' ><span class='gform-field-label__text'>I acknowledge and agree that my decision to travel is my personal decision and that my entry into Canada is subject to Canadian immigration laws including but not limited to mandatory quarantine orders. I acknowledge and agree that it is my obligation and responsibility to familiarize myself with all requirements to enter and stay in Canada.<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/legend><div class='ginput_container ginput_container_checkbox'><div class='gfield_checkbox ' id='input_287_17'><div class='gchoice gchoice_287_17_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_17.1' type='checkbox'  value='Confirmed'  id='choice_287_17_1'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_287_17_1' id='label_287_17_1' class='gform-field-label gform-field-label--type-inline'>Confirmed<\/label>\n\t\t\t\t\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_287_13\" class=\"gfield gfield--type-checkbox gfield--type-choice gfield--input-type-checkbox gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible gfield--choice-align-vertical\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' ><span class='gform-field-label__text'>I certify that the information submitted is to the best of my knowledge and belief, true, accurate and complete. I understand and agree that false or misleading information will have consequences to my UHIP coverage and immigration status.<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/legend><div class='ginput_container ginput_container_checkbox'><div class='gfield_checkbox ' id='input_287_13'><div class='gchoice gchoice_287_13_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_13.1' type='checkbox'  value='Confirmed'  id='choice_287_13_1'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_287_13_1' id='label_287_13_1' class='gform-field-label gform-field-label--type-inline'>Confirmed<\/label>\n\t\t\t\t\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_287_18\" class=\"gfield gfield--type-html gfield--input-type-html gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  >Personal information collected through this form will be used and disclosed by Carleton University under the authority of the Carleton University Act, 1952, and in accordance with sections 39, 41 and 42 of Ontario\u2019s Freedom of Information and Protection of Privacy Act. The purpose of this processing is enroll you into, and manage your registration with, the University Health Insurance Plan (UHIP).  \n\nThe information will be used internally by International Student Services Office to manage the plan. Some information will be disclosed to Cowan, the insurance plan administrator, in order for you to process benefits claims.  \n\nIf you have any questions about the processing of personal information by International Student Services Office, please contact the Manager, Privacy &amp; Access to Information, by phone at 613-520-2600 ext. 2047 or by e-mail via University_Privacy_Office@carleton.ca. <\/div><div id=\"field_287_34\" class=\"gfield gfield--type-captcha gfield--input-type-captcha field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_287_34'><span class='gform-field-label__text'>CAPTCHA<\/span><\/label><div id='input_287_34' class='ginput_container ginput_recaptcha' data-sitekey='6Lfdrx0TAAAAAHkdRF2Kx4AcYWl45yaLqJyIsqs8'  data-theme='light' data-tabindex='0'  data-badge=''><\/div><\/div><div id=\"field_287_5\" class=\"gfield gfield--type-section gfield--input-type-section gsection field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><h3 class=\"gsection_title\">Ineligible for UHIP Opt-out<\/h3><\/div><div id=\"field_287_30\" class=\"gfield gfield--type-html gfield--input-type-html gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  >You have indicated on the form that you are an international student currently residing in Canada for the Fall 2026 term. Accordingly, your enrolment in the University Health Insurance Plan (UHIP) continues to be mandatory and you are not eligible to opt out of coverage for this period. For more information about the UHIP plan, and coverage details please visit <a href=\"https:\/\/carleton.ca\/go-isso\/uhip\/uhip-for-students\/\">our website<\/a>.<\/div><div id=\"field_287_36\" class=\"gfield gfield--type-html gfield--input-type-html gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  >You have indicated on the form that you are an international student currently residing in Canada for the Winter 2027 term. Accordingly, your enrolment in the University Health Insurance Plan (UHIP) continues to be mandatory and you are not eligible to opt out of coverage for this period. For more information about the UHIP plan, and coverage details please visit <a href=\"https:\/\/carleton.ca\/go-isso\/uhip\/uhip-for-students\/\">our website<\/a>.<\/div><div id=\"field_287_37\" class=\"gfield gfield--type-html gfield--input-type-html gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  >You have indicated on the form that you are an international student currently residing in Canada for the Summer 2027 term. Accordingly, your enrolment in the University Health Insurance Plan (UHIP) continues to be mandatory and you are not eligible to opt out of coverage for this period. For more information about the UHIP plan, and coverage details please visit <a href=\"https:\/\/carleton.ca\/go-isso\/uhip\/uhip-for-students\/\">our website<\/a>.<\/div><\/div><\/div>\n        <div class='gform-footer gform_footer top_label'> <div class=\"gf-turnstile-container\"> <div id=\"cf-turnstile-gf-287\" class=\"cf-turnstile\" data-sitekey=\"0x4AAAAAAEBGc8WPyKQfO_8b\" data-theme=\"\" data-language=\"auto\" data-size=\"\" data-retry=\"auto\" data-retry-interval=\"1000\" data-refresh-expired=\"auto\" data-refresh-timeout=\"auto\" data-action=\"gravity-form-287\" data-callback=\"turnstileGravityCallback\" data-appearance=\"always\"><\/div> <script data-cfasync=\"false\">(window.cfturnstileQueue=window.cfturnstileQueue||[]).push(\"-gf-287\");if(window.cfturnstileRender)window.cfturnstileRender();<\/script> <br class=\"cf-turnstile-br cf-turnstile-br-gf-287\"> <style>#cf-turnstile-gf-287 { margin-left: -15px; }<\/style> <\/div> <style> .gf-turnstile-container { width: 100%; } .gform_footer.top_label { display: flex; flex-wrap: wrap; } <\/style> <script>document.addEventListener(\"DOMContentLoaded\", function() {document.addEventListener('gform\/post_render', function handlePostRender(event) {if (event.detail.formId !== 287) {return;}gform.utils.addAsyncFilter('gform\/submission\/pre_submission', async function handlePreSubmission(data) {document.addEventListener('gform\/post_render', function rerenderTurnstile(event) {if (event.detail.formId !== 287) {return;}const turnstileElement = document.getElementById('cf-turnstile-gf-287');if (turnstileElement) {turnstile.remove('#cf-turnstile-gf-287');turnstile.render('#cf-turnstile-gf-287', (typeof window.cfturnstileOpts === \"function\" ? 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