New Resource: Important Forms for New Students

Please read each section carefully, as specific instructions to submit the different forms are provided.

1. Housing Placement, Residence Hall Agreement and New Student Survey Form Email tressi_chun@pitzer.edu if interested in living on-campus
2. Photo Submission for Your Pitzer ID Card Due by Monday August 4, 2014
3. Orientation Adventure Trip Preference Form Due by Monday July 21, 2014
4. Medical Insurance Information Available beginning Tuesday, July 1, 2014. Due by September 5, 2014
5. Entrance Personal History/Medical Examination Report Form Due Friday, August 1, 2014. Must be submitted directly to CUC Student Health Services.
6. Request for Disability Services Form

1. Housing Placement, Residence Hall Agreement and New Student Survey Form

If interested in living on-campus, as a new resource student you will be placed with a roommate in Mead, West or East Hall. Housing placement and roommate matches are made based on the answers provided in the Housing Placement form. You will also need to fill out and sign the Pitzer College Residence Hall Agreement.

Housing Placement, Residence Hall Agreement and New Student Survey Form - Please submit an copy via email of your completed forms to newstudent@pitzer.edu.

For information on the residence halls that new resource students will be placed in and suggested items to bring with you in the fall, click here.

This form is in PDF format and may be filled out and saved to your computer.

Here are a couple of solutions to some common problems that students sometimes encounter with the PDF form:

  1. Do NOT fill out the form while it is opened in your browser. SAVE AS to your desktop as a separate file, then fill it out and save it.
  2. If you are using a MAC, do NOT use Preview to fill out the form. Use Acrobat Reader (the PDF software which is free and can be downloaded online), and make sure to “save as .pdf” when you save your document.
  3. Below is an example of how the form will appear in your browser. Select the “Save a copy” icon.

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2. Photo Submission for Pitzer ID Card

All new students need to submit a photo to be used for your Pitzer ID card. This can be done via email or mail. For specific instructions on how to submit this information by the deadline of Thursday August 4, 2014, please visit the Photo Submission website.

3. Orientation Adventure Preference Form

All transfer and NRS students are encouraged to participate in an Orientation Adventure trip as part of their broader orientation to Pitzer College, but are not obligated to do so. At this time, an Orientation Adventure trip is not an option for exchange students. Visit the Orientation website for more information about the OA program at www.pitzer.edu/newstudentorientation.

Orientation Adventure Trip Preference Form – Orientation Adventure registration for transfer students begins on Thursday July 10, 2014 and registration closes on Monday July 21, 2014. Trip placements will be announced on Tuesday July 22, 2014.

4. Medical Insurance Information – All New Students

Medical insurance is mandatory for all students.  All students will be automatically enrolled in the Claremont Colleges’ Student Health Insurance Plan unless they complete the waiver information via the online portal.  The portal will open July 1, 2014. In order to access the portal, you will have to enter your last name, date of birth and student ID number.  Please note that all new students will receive an e-mail the week of July 7th with instructions on how to access their ID number and the waiver portal.

Open enrollment for the fall semester begins July 1, 2014 through September 5, 2014. Open enrollment for the spring semester begins December 19, 2014 through January 23, 2015. Students can obtain a 100 percent refund one week before or on the first day of class. After the first day of class the medical coverage charge is non- refundable. It is the student’s responsibility to keep the College informed of changes in medical coverage and coverage must be confirmed every year.

In order to qualify for a waiver, students must have other insurance coverage, and benefits under that plan must include all of the following:

  •     Coverage must be continuous (no break or termination) for the entire academic year;
  •     Coverage must be effective prior to 8/24/2014;
  •     Maximum lifetime benefit must be at least $500,000;
  •     Deductible must be $1,000 or less per policy year;
  •     Claims must be paid by a U.S.-based company; and
  •     Underwriting company must be owned, operated, and headquartered in the
  •     United States and must be in full compliance with applicable federal laws.
  •     International students may not waive with insurance from their home country.

The portal will be open from July 1, 2014 to September 5, 2014.  An email will be sent to all students and parents the first week of July with a link to the waiver portal. If you do not enter your health insurance information, you will automatically be enrolled in the Claremont Colleges Student Health Insurance and your student account will be billed accordingly.

For frequently asked questions and more information:

If you have any questions or concerns, please contact the Office of Student Affairs 909.607.2821 or e-mail katie_tewell@pitzer.edu

5. Student Health Services – All New Students

Your Entrance Personal Health History/Medical Examination Report Form should be filled out and submitted directly to Claremont University Consortium (CUC) Student Health Services. Please review all the information thoroughly before submitting the completed form to CUC Student Health Services.  You may choose to submit your completed form by mail or email to shsrecords@cuc.claremont.edu

Please take a moment to visit the Student Health Services website at www.cuc.claremont.edu/shs as it contains important information such as the all of the SHS form including the entrance physical forms, psychiatric medication policy, and vaccine information. Although the Student Health Center is closed for the summer, you may access additional information regarding Student Health Services by visiting their website or calling and leaving a voicemail message at 909.621.8222 which is checked weekly.

6. Request for Disability Services Form

The Office of Student Affairs strives to accommodate the special needs of students who have been offered admission to Pitzer College. Pitzer College will make reasonable accommodations to students with documented disabilities. If you have a documented disability, please complete the Request for Disability Services Form to let us know what your disability is and what services you will need. For more information visit the Academic Support Services website, and please contact Jill Hawthorne, Associate Dean of Students and Director of Academic Support Services 909.607.3553 or jill_hawthorne@pitzer.edu