VSP Vision Care
2022-2023 Academic Year

ENROLLMENT FORM

 FOR STUDENTS REGISTERING FALL 2022  

 

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

Note: If you have a social security number you are required to enter it below. If you are an international student and do not have a social security, please use your student ID and add leading zeros if necessary to make it a 9-digit number.

Asterisk (*) denotes required field

STUDENT INFORMATION

 (MM/DD/YYYY)