Co-Op Student Opt-In Online Application

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Please ensure that you input the correct information below, as well as, provide a copy of your co-op registration or Work Term Agreement signed by your Co-op officer.

Email *

Student ID Number *

Program Name *

Campus Study * *

St. James

Casa Loma

Waterfront

Ryerson

Hospitality

Required

Program Start Date *

YYYY

First Name *

Last Name *

Gender *

Female

Male

Other

Required

Date of Birth *

YYYY

Phone Number *

E-mail *

Complete address including postal code *

Have you ever applied for opt out from the student benefits plan administrated by Student Association?

Yes

If you answer "yes", are you still under another plan?

Yes

If you answer “No”, please give date of loss of coverage.

YYYY

The plan I am choosing is (choose one of the following): *

There are 4 different plans you can choose from at no additional cost. To review the plan overview, you can visit https://wespeakstudent.com/home/47-george-brown-college/domestic-plan

Balanced Plan

Enhanced Drug Plan

Enhanced Dental Plan

Enhanced Extended Healthcare Plan

I understand that: *

I understand that the information provided above is required for me to complete the co-op opt-in application and be placed on the Student Association of George Brown College Student Health Benefits Plans, for the coverage period from September 1, 2025 and ending August 31, 2026.

I further understand that all information above is required to provide my extended health and dental benefits. This information will not be used in any manner except to provide coverage through the Student Association of George Brown College Health and Dental Benefits Plans, and/or administration of the plans.

I am required to re-apply for my health plan coverage at the initial start date of every academic year if I continue to be a co-op student.

I am required to submit a copy of my co-op registration to healthbenefits@sagbc.ca and complete the health benefit payment by Thursday October 2, 2025.

Required

Method of Payment

Please note that we only accept the following methods of payment. We will contact you with details to complete your payment, if you are eligible.

• Credit (Visa/Mastercard)
• Debit

A copy of your responses will be emailed to the address you provided.

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