International Student Services Forms Section

Student Health Insurance Plan Enrollment Request Form

Woman lying on the floor doing abdominal exercises at a gym or fitness center.

(Processing Time 3 Business Days)

IMPORTANT: Please do not use your back button once you begin this form. We also recommend you “Allow Cookies” to successfully submit this form. If you are having issues submitting your form, please see these Troubleshooting Tips.

First Name

Middle Name

Last Name

Academy Student ID

Please double-check your Student ID to ensure it is correct and ensure it begins with a zero (0), like this: 05555555

Email Address

Telephone

Date of Birth

Please enter in this format: MM/DD/YYYY

Please enter your U.S. address below:

Street Address

Street Address 2 (Apartment/Room/Unit Number)

City

State

Zip Code

I request to enroll in the Academy's Student Health Insurance Plan for the following semester:

Back to Schools

Schools

Back to Interdisciplinary Curriculum

Interdisciplinary Curriculum

Back to Our Campus

Our Campus

Back to Housing & Dining

Housing & Dining

Back to Current Students

Current Students

Back to Health & Safety

Health & Safety

Back to International Admissions

International Admissions

Back to Military & Veterans Education

Military & Veterans Education

Back to Schools

Schools

Back to Interdisciplinary Curriculum

Interdisciplinary Curriculum

Back to Our Campus

Our Campus

Back to Housing & Dining

Housing & Dining

Back to Current Students

Current Students

Back to Health & Safety

Health & Safety

Back to International Admissions

International Admissions

Back to Military & Veterans Education

Military & Veterans Education

Student Health Insurance Plan Enrollment Request Form

(Processing Time 3 Business Days)