Elms College
Domestic Student Health Insurance Enrollment Form

Spring Term 2020
January 18, 2020 - August 14, 2020

The enrollment deadline date is January 31, 2020

Please note:   You must be registered in 9 or more credits in order to be eligible to enroll in the Student Health Insurance Plan.


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

Asterisk (*) denotes required field

STUDENT INFORMATION

 
 (MM/DD/YYYY)