Delta Dental Plan Option for
George Washington University Students

DELTA DENTAL PPO PLAN
Spring 2025 Policy Period Enrollment Form

The enrollment deadline for coverage effective January 1, 2025 through August 31, 2025 is December 15, 2024. Enrollment will be processed after the deadline. Once processed, enrollment will be effective January 1, 2025.

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

*if you are an international student and do not have a social security number, please use your student ID replacing the "G" with a zero if necessary to make a 9-digit number