NICHOLS COLLEGE
STUDENT HEALTH INSURANCE PLAN

2018-2019 Academic Year

Annual Term Enrollment Form

For all New and Returning Students

This form is for all Day students enrolled in the Fall 2018 semester.


TO CONTINUE THE ENROLLMENT PROCESS, PLEASE FILL OUT THE REQUIRED FIELDS BELOW. PLEASE NOTE YOU WILL NEED TO USE YOUR NICHOLS COLLEGE EMAIL ADDRESS IN THE FOLLOWING FORMAT:  firstname.lastname@nichols.edu

first name:
last name:
date of birth: (MM/DD/YYYY)
email address: