T.P.E Student Opt-In Online Application
Please ensure that you input the correct information below, as well as, provide a copy of a letter from the T.P.E department of George Brown College.
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Email *
Student ID Number *
Program Name *
Campus Study *
Required
Program Start Date *
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/
DD
/
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First Name *
Last Name *
Gender *
Required
Date of Birth *
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/
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/
YYYY
Phone Number *
E-mail *
Complete address including postal code *
Have you every applied for opt out from the student benefits plan administrated by Student Association?
If you answer "yes", are you still under another plan?
If you answer “No”, please give date of loss of coverage.
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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
I understand that: *
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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