Menumenu button

Individual Enrolment Form

Submission Deadline: Friday, January 20th, 2017

Student Benefits Plan coverage is provided to eligible students automatically, except in certain circumstances where a student’s enrolment status excludes them from automatic inclusion by the institution or due to a previous opt-out form on file. To enroll in the Student Health and/or Dental plan(s), complete the sections below and submit this form. You will then be contacted by the Student Benefit Plan Office, via an email notification, of any required supporting documents and/or fees. All supporting document(s) and/or fees must be received by the applicable deadline in order for the enrolment process to be completed.

Please read and agree to the Terms & Conditions prior to submitting your online enrolment form.

You must only complete this form if you are in an eligible program and were not charged the fees or have opted out in the past.  

Student Information

Date of Birth
Phone Number
Program Start Date

Service Members

Find a Practitioner