Skip to main content Skip to main menu

FITCHBURG STATE UNIVERSITY
Student Health Insurance Program

Annual Enrollment Form 
2025-2026 Academic Year


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

PLEASE NOTE: You must enter your Student ID number below, with the "@" symbol in front, in order to proceed. Entering your social security number will not allow you access to the enrollment form.

Asterisk (*) denotes required field

 (MM/DD/YYYY)