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Illinois Institute of Technology
STUDENT HEALTH INSURANCE PLAN

2025-2026 Annual Dependent(s) Enrollment Form 
 

If you are enrolled in the Student Health Insurance Plan (SHIP), you may purchase the plan for your eligible dependents (lawful spouse, civil union partner, or children) through this online form. The deadline to enroll your dependents September 1, 2025. 

You must select the same coverage period for dependents as the student is enrolled. If the student is enrolled in annual coverage, you must enroll dependents in annual coverage. 

Asterisk (*) denotes required field

 (MM/DD/YYYY)