Request to Enroll in Student Blue - Student Health Insurance Plan
Co-Op, Student Intern, or Student Teachers are eligible to enroll in Student Blue. However, enrollment is is not required.
-individual is enrolled in at least 6 credit hours for undergraduate or 3 credit hours for graduate students.
-individual is degree-seeking, participating in a campus-sponsored internship, a co-op semester, or student
teaching that is required as a part of the academic degree program.
Would you like to enroll in the Student Blue - Student Health Insurance Plan?
No - if you do not wish to enroll, DO NOT complete this form. No further action is needed.
Page 1 of 2
Never submit passwords through Google Forms.
This form was created inside of UNC Charlotte.