Cambridge College
STUDENT HEALTH INSURANCE PLAN

​​Dependent Enrollment Form 
2021-2022 Academic Year

Students who are eligible for the Cambridge College Student Health Insurance Plan (SHIP) may use this form to enroll eligible dependents in the plan. Eligible dependents are the spouse, domestic partner, or child(ren) under age 26. 

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

Asterisk (*) denotes required field

STUDENT INFORMATION

 (MM/DD/YYYY)