Get Delivery Date: Friday, August 03, 2007 - Office Of Student Health ... - Shb Umn

Filling out the Delivery Date form for the Office of Student Health is an essential step for enrolling in the Graduate Assistant Health Plan. This guide will provide you with a clear and structured approach to ensure that all necessary fields are correctly completed.

Follow the steps to complete your form accurately and efficiently.

1. Click the ‘Get Form’ button to obtain the form and open it in your online editor.
2. Begin by filling in your Graduate Assistant Information. This section includes your full name, date of birth, gender, and University of Minnesota ID number. Ensure all entries are accurate and clearly stated.
3. Provide your current street address, city, state, ZIP code, daytime phone, and UMN email address. Accuracy in this section is important for any communication regarding your health plan.
4. In the enrollment section, check the box indicating your wish to enroll in the Graduate Assistant Health Plan. Be aware that the cost of your coverage will depend on your appointment type.
5. Proceed to the Dependent Enrollment Information section if you are enrolling dependents. Choose the appropriate plan for each dependent and ensure all dependents' names and birthdates are filled in correctly.
6. Verify your selections and ensure the total number of dependents does not exceed the form's capacity. If more than three dependents are to be covered, attach an additional sheet with their information.
7. Sign the Graduate Assistant Signature section. Remember that electronic signatures will not be accepted, so you must provide a handwritten signature.
8. Fill out the payment section only if you have dependents enrolled. Specify your payment method, including checks or credit card details, ensuring that you authorize the charges correctly.
9. Once all sections are completed, save your changes. You have the option to download, print, or share the form for submission to the Office of Student Health Benefits.

Begin your enrollment process online today by completing the necessary forms!