Please provide the address, city, state, zip code, and phone number of the authorized parent/agency/sponsor below:
**Notice:You will need to waive/accept your Student Health Insurance charge by creating an account and logging into Gallagher Student
Your printed first and last name and Student ID will serve as your electronic signature for the purposes of the releases above.
Student Financial Services
Email: firstname.lastname@example.orgPhone: 413–236–3043