Quick Links

Forms and Applications

Enrollment Forms and Applications

2013-2014 UCF CMMS IEP Hardwaiver Dependent Enroll.pdf

2013-2014 UCF Optional Major Medical Dependent Enrollment.pdf

2013-2014 UCF Continutation Plan Letter and Enrollment Form - Hardwaiver Program.pdf

Change of Name Request Form.pdf

For the application and information about On Call Travel Assistance and Medical Evacuation programs, please click the "Other Insurance Products" tab to the left.

All documents are in .PDF format. In order to read and print your enrollment form, you will need to have Adobe Reader downloaded and installed on your computer. You may click on the image below to download Adobe Reader.

  • Gallagher Student Health & Special Risk
    500 Victory Road, Quincy, MA 02171
  • Phone
  • Toll Free
  • Fax
  • Email