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Forms and Applications

Enrollment Forms and Applications

2015-2016 Florida International University - Continuation Plan.pdf

2015-2016 Florida International University CADIVI Letter Request.pdf

2015-2016 Florida International University Medical Leave of Absence Form.pdf

2015-2016 Florida International University Enrollment Form - Travel Assistance.pdf

Change of Name Request Form.pdf

For 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
    617-769-6047
  • Toll Free
    877-498-5468
  • Fax
    617-479-0860
  • Email
    fiustudent@gallagherstudent.com