Delta Dental Plan Option for
George Washington University Students

DELTA DENTAL PPO PLAN
2024-2025 Policy Year Enrollment Form

The enrollment deadline for coverage effective September 1, 2024 through August 31, 2025 is August 15, 2024.

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