Rhode Island School of Design

Pre-College Summer 2019 Program

Student Health Insurance Plan Enrollment Form

The enrollment deadline date is June 15, 2019. If you purchase the plan now, your coverage will be effective 06/22/19 - 08/03/19.

 

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

Asterisk (*) denotes required field

STUDENT INFORMATION

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

 

Student Health Plan

Optional Plans

Additional Information