Get Student Eligibility Form - The Co-operators

Completing the Student Eligibility Form - The Co-operators is a crucial step in ensuring that students receive the necessary benefits. This guide aims to provide clear and supportive instructions for filling out the form completely and accurately, ensuring that all necessary information is included to avoid any delays.

Follow the steps to complete the form successfully

1. Press the ‘Get Form’ button to obtain the form and open it in your preferred online document manager.
2. Begin with the General Information section, which is mandatory. Fill in the Effective Date of Change in the format MMM/DD/YYYY, along with the Group, Account, and Certificate information. Provide your Group Name, Plan Member’s first name, initial, and last name.
3. Proceed to the Dependent Information section. Here, you must provide the First Name, Initial, and Last Name of the dependent. Include their Date of Birth in the format MMM/DD/YYYY. Indicate whether the student is a Full-time student by providing enrollment dates (starting and ending) in the specified formats.
4. Answer the question regarding whether the student will be graduating at the end of the indicated school year. Select 'Yes' or 'No' as appropriate, noting that a 'Yes' will affect coverage.
5. Repeat the steps in Step 3 for any additional dependents, ensuring to fill out all relevant fields for each one thoroughly.
6. In the Privacy and Plan Member Signature section, read the Co-operators Life Insurance Company Privacy Statement carefully. Then, acknowledge your understanding and consent by signing and dating the form in the provided spaces.
7. Review all entries to ensure accuracy and completeness. Make sure all required fields are filled out properly.
8. Once you have completed and reviewed the form, you can save your changes, download the form for your records, and if necessary, print or share it as required.

Start filling out your Student Eligibility Form online today to ensure you receive your benefits promptly.