Quick Links

Forms and Applications

Enrollment Forms and Applications

2013-2014 FGCU Travel Assistance Enrollment Form.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
    617-769-6404
  • Toll Free
    877-537-5268
  • Fax
    617-479-0860
  • Email
    fgcustudent@gallagherstudent.com