Fillable LSUHSC OPTIONAL FEE CHECK LIST ACADEMIC YEAR 2021/2022 (LSU Health New Orleans)

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LSUHSC OPTIONAL FEE CHECK LIST ACADEMIC YEAR 2021/2022 (LSU Health New Orleans)

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Revised 04/26/2021
LSUHSC – OPTIONAL FEE CHECK LIST
ACADEMIC YEAR 2021/2022
NAME:
SCHOOL/LEVEL:
EMPLID #:
SELECT INCOMING SEMESTER: FALL ‘21 SPRING ‘22 SUMMER ‘22
Listed below are optional fees that students must elect on an individual basis. Please select all
fees that apply. Prices below reflect incoming Fall semester & continuing student prices. For
students who enroll during the Spring & Summer semesters amounts will be prorated
accordingly.
STUDENT HEALTH INSURANCE
Health insurance coverage is an LSUSHC requirement. All students must attach the Student Accident
and Sickness Plan form. The Needle Stick fee is an insurance policy that covers tests and treatment
required if a student is stuck by a needle or splattered with blood.
offered by LSUHSC.
Health Insurance Plan – $2,857.20 Semi-Annual Premium – I agree to purchase the health
insurance
I understand that I am required to purchase the Needle Stick fee and provide proof of insurance with
this packet. (copy of front and back of insurance card is sufficient proof)
Needle Stick Fee – $16.54 Semi
-Annual Premium – I have personal hea
lth insurance.
STUDENT PARKING
Parking Gate Card – $25 (refundable deposit) – Required for First Time Enrollees
Commuter Parking Permit – $125 annually
Residence Hall Parking Permit – $155 annually
SIGNATURE:
DATE:
*FEES ARE SUBJECT TO CHANG
E WITHOUT NOTICE*
Submit registration pa
cket to:
Bursar Operations
433 Bolivar St., Room 144
New Orleans, LA 70112
E-Mail: nobursar@lsuhsc.edu
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LSUHSC OPTIONAL FEE CHECK LIST ACADEMIC YEAR 20212022 (LSU Health New Orleans)

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Completed 21 July 2021

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