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Ithaca College
STUDENT HEALTH INSURANCE PLAN

Graduate Student Early Enrollment Form
Summer Coverage 5/10 or 7/10 Start

Important: Students MUST be approved from Ithaca College for either the early 5/10/25 or 7/10/25 effective coverage date. This is for new incoming graduates approved through Ithaca College ONLY. Current students who waived annual or spring coverage MUST have a qualifying life event to enroll.

Once your enrollment form is received and eligibility is confirmed, the student health insurance fee will be added to your student account. Enrollment will not be processed until eligibility is confirmed. 

Asterisk (*) denotes required field

STUDENT INFORMATION

 (MM/DD/YYYY)