Get Department Authorization Form - Office Of Student Health Benefits
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How to fill out the Department Authorization Form - Office Of Student Health Benefits online
Filling out the Department Authorization Form for the Office of Student Health Benefits is an important step for graduate assistants and trainees looking to enroll in the health plan. This guide provides clear, step-by-step instructions to help you complete the form accurately and efficiently.
Follow the steps to complete the form effectively.
- Press the ‘Get Form’ button to access the form and open it for editing.
- In section A, fellow or trainee information, fill in your name (last, first, middle initial), date of birth, gender, and university ID number. Ensure you provide a valid street address, city, state, zip code, daytime phone number, and email address.
- Continue in section A by indicating your graduate program and job class. Please choose whether this form is for you as a fellow/trainee or for a dependent by marking the appropriate checkbox.
- Move on to section B for payment information. Complete the mandatory fields, including the account string (EFS number) that will be charged and, if applicable, the eight-digit project code.
- Provide the amount to be charged for the fall semester and specify the fall period covered (between 09/01/2011 and 01/31/2012). Repeat this for the spring and summer semesters, ensuring you list the respective amounts and coverage periods.
- In section C, enter the department contact's name, campus address, daytime phone, and email address. This section also requires the date signed and the contact's signature. Remember, electronic signatures are not accepted.
- Finally, review all provided information carefully for accuracy. Once complete, save your changes. You can then download, print, or share the form as needed.
Complete your Department Authorization Form online today to ensure your health benefits enrollment is processed smoothly.
To qualify for Michigan State insurance, students must meet certain criteria set by the university. The application process typically involves submitting the Department Authorization Form - Office Of Student Health Benefits along with proof of enrollment. It's best to check with the student health center for specific requirements and guidelines to ensure you are eligible.
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