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Brandeis University
STUDENT HEALTH INSURANCE PLAN

Annual Enrollment Form
2024-2025 Academic Year

TO CONTINUE THE ENROLLMENT PROCESS, PLEASE FILL OUT THE REQUIRED FIELDS BELOW

You must use your Brandeis email to access the form. Your Brandeis email (UNet Account) is your official email address. Brandeis will begin using it immediately for all official communications. If you do not have a Brandeis email address, please follow the instructions below.

For New Students: To create a new Brandeis email account (UNet Account), please visit Library and Technology Services website, click on "New Account (student, faculty, staff, contingent worker, alumni)", and follow the instructions. You will need to have the SAGE (Student Administration Gateway) ID number provided to you by your Admissions Center.

Asterisk (*) denotes required field

 (MM/DD/YYYY)