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RUTGERS UNIVERSITY
STUDENT HEALTH INSURANCE PLAN

2025-2026 Policy Year 

Full-Time Student Spring Leave of Absence Enrollment Form

Full-time students who are on an approved leave of absence and wish to enroll in the Student Health Insurance Plan are eligible to purchase coverage for a period of up to 12 consecutive months* under the Rutgers SHIP. To be eligible to submit this form, you must (1) be on an approved leave of absence, (2) intend to return to Rutgers University after your leave and remain a degree-seeking candidate. Part-time students are not eligible for leave of absence enrollment.


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

Asterisk (*) denotes required field

STUDENT INFORMATION

 (MM/DD/YYYY)