UNIVERSITY OF DELAWARE

DENTAL ENROLLMENT FORM FOR
UNDERGRADUATES AND NON-CONTRACTED GRADUATES
2024-2025 POLICY YEAR

Students and dependents who wish to enroll MUST complete this from by October 15, 2024.

This is a voluntary dental plan offered to University of Delaware Undergraduate and Non-Contracted Graduate students.

Please complete the fields below to continue:

INTERNATIONAL STUDENTS: If you do not have a social security number, please use your visa number in the "social security number" field below.