Elms College
International Student Health Insurance Enrollment Form

Annual Term 2019
August 15, 2019 - August 14, 2020

The enrollment deadline date is August 31, 2019

Please note:   You must be registered in 9 or more credits in order to be eligible to enroll in the Student Health Insurance Plan.


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

Asterisk (*) denotes required field

STUDENT INFORMATION

 
 (MM/DD/YYYY)