All deadlines for forms and documents are listed by due date and should be returned to the corresponding office in the information below.
For scanned/emailed forms and the Student Health Services health information packet, mail forms to: Harvey Mudd College Office of Dean of Students, 301 Platt Blvd., Claremont, CA 91711
All incoming students are required to designate a tuition payment method and have several payment options. Please make sure to initial your payment choice and sign the form. A scanned or faxed copy is considered preliminary information only, and a hard copy sent in by mail is necessary.
Substitute W-9S Form (PDF) (Student Only)
Only incoming students who did not provide their SSN or ITIN on the Common Application or FAFSA, or those who provided invalid SSNs or ITINs will be required to submit this form. Please do not submit this form unless you have received a request from the Office of Student Accounts. An email will be sent in mid/late May to the students who are required to submit this form.
The United States Internal Revenue Service requires the university to collect the name, social security number (SSN), and dollar amount of all students’ qualifying payments and report that information on IRS Form IRS Form 1098-T. This information provides the IRS with a basis for amounts claimed by a taxpayer as qualifying expenditures for higher education tax credits such as the American Opportunity Credit. Even if you are not eligible for any education tax credits, IRS regulations stipulate that a 1098-T be issued for any student who has qualified charges, regardless of your eligibility for the tax credit. Failure to provide us with a SSN may result in the student being fined by the IRS in accordance with Internal Revenue Code Section 6723 (PDF).
Since this form contains your SSN or ITIN, for security reasons, please DO NOT EMAIL the Substitute W-9S or attach the Substitute W-9S to an email. Please mail this in with your Tuition Payment Agreement (or alone) to:
Harvey Mudd College Student Accounts
301 Platt Blvd.
Claremont, CA 91711
It is essential for you to complete the Roommate Matching form thoroughly and honestly (no parents peeking). Only a few people read the forms, and they are kept confidential. New Student Orientation Leaders in collaboration with DOS staff will very carefully try to make a workable match of you and a roommate as well as you and a dorm. Questions should be directed to the dean of students office at 909.621.8125 or firstname.lastname@example.org.
The form is relatively short and should not take much time to complete. It asks for general information, family contact information, emergency contacts and meal plan choice. Questions should be directed to the dean of students office at 909.621.8125 or email@example.com.
Each Harvey Mudd student living on campus is required to read and sign a housing agreement. Please note: Students who will be under 18 at the time of move-in will need to have a parent sign a paper version of the contract before the end of Orientation. Questions should be directed to the dean of students office 909.621.8125 or firstname.lastname@example.org.
Please note: Students will need to be logged into their Harvey Mudd Google Apps for Education accounts to be able to sign the contract.
Student Health Insurance Plan (SHIP)
*The 2015–2016 Waiver Portal will open Friday, June 5 for incoming and returning students*
**Please note that all International Students will be required to enroll in SHIP**
What is SHIP?
SHIP is a health insurance plan designed just for students attending The Claremont Colleges. The plan is available to protect your educational future. If you get sick or injured, insufficient health insurance can lead to financial hardships that can threaten your ability to attend class, pay tuition, get student loans or live away from home. Having health insurance helps to ensure that you are able to stay in school, so you can graduate and achieve your personal goals. SHIP is available to all matriculated domestic students and all international students attending on a student visa (F-1,J-1 or M-1).
Am I required to have health insurance?
Yes. All continuing students or newly matriculated students are required to have health insurance coverage. You will be automatically enrolled in SHIP, unless proof of comparable coverage is provided and a waiver is submitted by the waiver deadline date. If you have other insurance—such as coverage as a dependent under a parent’s or spouse’s insurance plan—and you do not wish to enroll in SHIP, you may submit a waiver application. Please note: International students are not allowed to waive SHIP.
What is a health insurance waiver application?
A health insurance waiver application is a form that you fill out if you have other qualifying health insurance and do not wish to be enrolled in SHIP. You can submit an online waiver application. As part of the waiver process, you are required to provide specific information about your insurance coverage, which will be verified by the school or a designated waiver administrator.
Does my other insurance qualify?
If you wish to waive SHIP because you have other insurance, benefits under that plan must meet the following requirements:
- Coverage must be continuous (no break or termination) for the entire academic year.
- Maximum lifetime benefit must be at least $500,000.
- Coverage must be effective prior to 08/27/2015.
- Deductible must be $1,000 or less per policy year.
Your insurance coverage will be verified. Students who are covered under a health insurance plan that does not meet all of the applicable requirements will not be allowed to waive out of SHIP.
What if my deductible is over $1,000 per policy year?
You can submit the Harvey Mudd High Deductible Form and upload it directly through the waiver portal on Ascension’s website.
Should I waive SHIP?
If you have other coverage that meets the waiver criteria, it is your decision whether to waive SHIP. However, here are some important things to consider first:
- SHIP may be less expensive than being insured on an individual plan or as a dependent on an employer group plan through your parent or spouse. When comparing costs, be sure to look at premiums, deductibles, co-payments and out-of-pocket maximums.
- SHIP has a local PPO provider network. If you have out-of-state coverage, or HMO or PPO coverage with a limited provider area, there may not be any network providers near school. You may have to pay higher out-of-network co-payments, deductibles or co-insurance.
Please note: If you waive coverage under SHIP, you are responsible for any medical costs you incur.
How often do I have to submit a waiver application?
Students who wish to waive out of SHIP must complete the online application once each academic year by the deadline date.
What happens if I don’t waive by the deadline date?
Students who do not submit a waiver application by the deadline date with be automatically enrolled in SHIP.
If my insurance coverage starts after the semester begins, can I get a refund?
If it is past the waiver deadline, your SHIP coverage remains in place and you will have to wait until next academic year to waive out of SHIP. No refunds will be issued.
What if I successfully waive out of SHIP, then lose my other coverage?
You may enroll in SHIP mid-year if you waived out but later lost coverage through no fault of your own, such as coverage that terminates due to loss of employment (by your spouse or parent) or by reaching an age limit set by the plan. This does not include coverage that has a predetermined termination date, expiration of COBRA eligibility or coverage that has been voluntarily or inadvertently terminated by you (by quitting a job or missing an enrollment deadline, for instance). To enroll mid-year after an involuntary loss of coverage, you must notify Student Health Services and submit proof of loss of coverage within 31 days of termination of said coverage. You will be charged the full cost of the term in which you are enrolling in SHIP. Please note: The deadline for waiving out of SHIP is June 27, 2014. If a waiver has not be approved by the deadline, you will be charged for the first installment in the July 1 billing. For more information, please contact Patricia Wang in Student Accounts at 909.621.8107 or email@example.com. General questions regarding health insurance may be directed to the dean of students office at 909.621.8125 or firstname.lastname@example.org.
For more information on SHIP and dates the waiver portal will open please see our Student Health Insurance page
Final grades and high school transcripts
You must submit an official final high school transcript to the Office of Admission. Your admission and final enrollment at Harvey Mudd are contingent on the successful completion of the spring term. Questions should be directed to the Office of Admission at 909.621.8011 or email@example.com. Transcripts should be mailed to: Harvey Mudd College Office of Admission 301 Platt Boulevard Claremont, CA 91711
During Orientation, there will be a two day trip that all incoming students participate in. Let us know what your trip preference is! If you have any questions, please contact the NSO Leaders: Joanna Ho firstname.lastname@example.org and Ace Bansal email@example.com.
If you will be under 18 years old on the date you arrive at Mudd, your parent or guardian must complete this form. Since hospitals cannot treat minors without the consent of a parent or guardian, this mandatory form allows you to receive emergency medical treatment in the event a parent or guardian cannot be reached. Questions should be directed to the dean of students office at 909.621.8125 or firstname.lastname@example.org.
Please take a moment to upload a photo, which will be used by various departments in preparation of your arrival. (If prompted, use your Harvey Mudd College credentials to log in.)
Please Note: Visual Media Waiver: Harvey Mudd College reserves the right to photograph and/or videotape students, faculty, staff and guests while on College property, during College-sponsored events or during activities where they are representing the College. These images and audio may be used by Harvey Mudd College for promotional purposes, including use in/on the College magazine, press releases, booklets, brochures, flyers, newsletters, advertisements, the College website, associated websites and other promotional materials. This serves as public notice of the College’s intent to do so and as a release of permission to the College to use such images as it deems fit. If you object to the use of your image, you have the right to withhold its release by contacting the Office of Communications and Marketing at 909.607.6722 or email@example.com.
Student Health Services Information forms
This document includes a cover letter that explains the “Entrance Personal Health History/Medical Examination Report Form” (PDF). You must complete this form before you can use Student Health Services. Some immunizations are also required. The Information on Meningitis (PDF) document includes a letter explaining the risks of meningitis at college and recommends that incoming students get immunized against it. The final parts (PDF) of the form include the Health History and Exam Form and an emotional health history form. Please note: Send this packet with all health exam and history forms directly to Student Health Services at 757 College Way, Claremont, CA 91711, by August 1. Visit Student Health Services for more information. Please note: Student Health Services is closed over the summer break, but if you have questions you may call them at 909.621.8222 and leave a message. SHS retrieves and responds to voice mail daily.
- Writing 001 Preference Form
AlcoholEdu and Haven Programs (Will be open late July)
You are expected to complete AlcoholEdu and Haven. You will need one EverFi Higher Education Account to access these courses from your dashboard. We urge you to add all courses to your dashboard before beginning any of the content.
1. Go to the EverFi website.
2. Enter a Registration Code (listed below)
3. Once at your EverFi Dashboard, click Add a Course and enter the Registration Code
Note: You must use your Harvey Mudd email address to ensure that you receive credit for completion:
For Example: firstname.lastname@example.org
AlcoholEdu has several parts: an initial self-assessment, the course itself, a final assessment and a follow-up survey sent to you in the middle of fall semester. Your information will be confidential, and Harvey Mudd College will only see aggregated responses. The initial course takes 2–3 hours to complete and includes several videos and quizzes, so you have the option to complete it in multiple sessions. Just be sure to hit the “Next” button at the end of a section before you log out. Otherwise, you’ll need repeat any unsaved sections. Here’s how to access it:
- Go to EVERFI
- Enter your AlcoholEdu for College Registration Code: c115409a
- Enter your first name, last name and Harvey Mudd email address (email@example.com) and then create a password. You may also need to enter your birth date for confirmation.
- If you’re in Summer Institute, choose that group. Otherwise, you’re a First Year Student.
- If you have questions, click on the “Technical Help” drawing in the upper-right corner of the site page.
Haven Course- Sexual Assault Prevention
Registration Code: 47834064
Please be sure to carefully review the list of required incoming students’ forms and materials before starting at Harvey Mudd College (Sakai login required). (You will receive your Sakai log-in when you receive your Harvey Mudd College email address) Blank boxes indicate forms that may be received at the College but have not yet been tallied.
Please allow up to a week for forms to be received by the proper office, as well as for additional website updates. Forms not sent to the dean of students office may experience delays in being tallied. Red boxes indicate overdue forms that have not been completed by last accounting and should be submitted as soon as possible. Yellow boxes indicate forms that were not submitted in a complete fashion; if there is a yellow box near your name, you should have received an email instructing you on how to proceed. For foreign exchange students, a gray box indicates that that form doesn’t apply to you; for other students, a gray box indicates that a form past-due was not turned in and can no longer be completed (such as the Writing Course Preference forms), or that a form is inapplicable. Please refer to the following recap of the forms discussed above:
- Roommate Matching Form
- Student & Family Information Form
- Tuition Payment Agreement
- Writing 001 Preference Form
- Student Health Services Information
- Consent to Treatment of a Minor (required for minors only)
- Final High School Transcript
- Health Insurance Waivers (for those not enrolling in SHIP)