Rhode Island School of Design

Pre-College Summer 2018 Program

Student Health Insurance Plan Enrollment Form


The enrollment deadline date is June 15, 2018If you purchase the plan now, your coverage will be effective 06/22/18 - 08/06/18.

 


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)