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Simmons University

Undergraduate Student Health Insurance Plan 
Annual Enrollment Form
2024-2025 Academic Year


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

Please note if you just registered for classes you will have to wait a week to complete the form. Simmons University updates the authorization list for access to the forms once a week.

Asterisk (*) denotes required field

 (MM/DD/YYYY)