A completed and notarized Affidavit of Domestic Partnership must be submitted when enrolling or submitting a life event (qualified status change) through eBenefits, the student health insurance portal. Documentation to verify that the domestic partnership meets the criteria described in the University of Pittsburgh Affidavit of Domestic Partnership will be required. Once the completed affidavit and supporting documentation has been submitted, it will be reviewed and the student will be contacted with the approval, denial, or if additional information is required.

Affidavit of Domestic Partnership for Undergraduate and Graduate Students

Note: A domestic partnership, as defined by the University of Pittsburgh, is defined as a committed relationship between two adults of the same or opposite sex, which meet the criteria described in the University of Pittsburgh Affidavit of Domestic Partnership.

Required Documentation

Shared financial obligations, as demonstrated by fulfilling at least two (2) of the following criteria, are required when establishing a domestic partnership with the University:

1. Student and domestic partner have been common or joint owners of a residence (house, condominium, or mobile home) or held a common or joint residential lease identifying both partners as tenants for at least 12 consecutive months prior to the application date
2. Student and domestic partner have shared at least two (2) of the following for at least 12 consecutive months prior to the application date:
   • Joint ownership of a motor vehicle
   • Joint checking account or joint savings account
   • Joint credit account
3. The domestic partner has been designated as a primary beneficiary on one (1) of the following for at least 12 consecutive months prior to the current date:
   1. Student's life insurance policy
   2. Student's retirement program
   3. Student's will OR domestic partner and student have a reciprocal durable Medical Power of Attorney for the past 12 months OR domestic partner and student have a sanctioned union by a governmental body for the past 12 months

Note: Documentation establishing the existence and duration of any of these criteria may be required when establishing the domestic partnership with the University.