Framingham State University

YES, I WANT TO ENROLL IN THE FRAMINGHAM STATE UNIVERSITY
STUDENT HEALTH INSURANCE PLAN
2015-16 ACADEMIC YEAR


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

Asterisk (*) denotes required field

STUDENT INFORMATION
 
student ID:
first name: *
last name: *
date of birth: * (MM/DD/YYYY)
last 4 digits of social security number: