Simmons College

Graduate Student Health Insurance Plan
Annual Enrollment Form
August 15, 2017 - August 14, 2018


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

Please note if you just registered for classes you will have to wait a week to complete the form. Simmons College updates the authorization list for access to the forms once a week.

first name:
last name:
date of birth: (MM/DD/YYYY)
Student ID: