Health Insurance Enrollment Specialists at SDSU
Please complete this form to begin the process of connecting with an Enrollment Specialist about health insurance (Medi-Cal or Covered California Marketplace). You will hear back from someone within 2 business days.
* Required
Email address
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Your email
Name
*
Your answer
Phone Number
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Your answer
Do you have health insurance?
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Yes
No
Would you like assistance applying for health coverage?
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Yes
No
Maybe
Tax filling status
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Primary tax filer
Dependent (under parent / legal guardian)
I don't make enough to file
What is your tax household size (The taxpayer(s) and any individuals who are claimed as dependents on one federal income tax return. A tax household may include a spouse and/or dependents).
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Your answer
Current Monthly Gross Income (before taxes are taken)
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Your answer
Do you want us to send you information about CalFresh food assistance?
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Yes
No
Any other information you would like us to know?
Your answer
A copy of your responses will be emailed to the address you provided.
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