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Indiana University
International Student
Insurance Plan

Dependent Enrollment Form 
2024-2025 Academic Year

International Students may enroll their dependents on a semester-by-semester basis by completing the dependent enrollment form by the deadline. Eligible dependents include the student’s spouse and unmarried children under the age of 26. Documentation to support dependent status is required at the time of enrollment, such as a marriage certificate or birth certificate. 

Asterisk (*) denotes required field

 (MM/DD/YYYY)