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UNIVERSITY OF DELAWARE

DENTAL ENROLLMENT FORM FOR
UNDERGRADUATES AND NON-CONTRACTED GRADUATES
2025-2026 POLICY YEAR

Students and dependents who wish to enroll MUST complete this from by October 15, 2025.

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


Please complete the fields below to continue:

 

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STUDENT INFORMATION

 (MM/DD/YYYY)