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Salve Regina University
STUDENT HEALTH INSURANCE PLAN

Annual Enrollment Form
2026-2027 Academic Year


I want to purchase the Salve Regina University Student Health Insurance Plan. I understand my student account will be billed the annual insurance premium of $2,050.

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

Asterisk (*) denotes required field

STUDENT INFORMATION

 (MM/DD/YYYY)