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Wake Forest University School of Medicine
STUDENT HEALTH INSURANCE PLAN

Dependent Enrollment Form 
2024-2025 Academic Year

Students who are eligible for the Wake Forest School of Medicine Student Health Insurance Plan (SHIP) may use this form to add eligible dependents to the plan. Eligible dependents are the spouse, domestic partner, or child(ren) of a Wake Forest School of Medicine student who is also enrolled in the SHIP. 


To continue the enrollment process, please fill out the required fields below:

Asterisk (*) denotes required field

 (MM/DD/YYYY)