Framingham State University

YES, I WANT TO ENROLL IN THE FRAMINGHAM STATE UNIVERSITY
STUDENT HEALTH INSURANCE PLAN
2016 SPRING SEMESTER


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

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STUDENT INFORMATION
 
first name: *
last name: *
social security number:
student ID:
date of birth: * (MM/DD/YYYY)