Gordon-Conwell Theological Seminary
STUDENT HEALTH PLAN

2019 - 2020 Enrollment Form

Annual Term 2019

Returnung and New incoming Students for Fall Term 2019 taking 6+ credits at both South Hamilton and Boston should complete this form to confirm and expedite enrollment for the GCTS Student Health Plan for the Spring Semester. Dependent coverage may also be elected using this form.

If you do not complete this enrollment form by the DEADLINE of midnight on September 13, 2019 you will be automatically enrolled in the Student Health Plan with a "Student Only" plan. After September 28, 2019, you will not be able to add a dependent to your plan during this academic year unless your dependent has experienced a qualifying event.


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

Asterisk (*) denotes required field

STUDENT INFORMATION

 
 (MM/DD/YYYY)