Forms and Applications
Enrollment Forms and Applications
If you are a graduate student or are a student enrolled in Practicum Training, an Internship, or a Special Program and you wish to enroll in the plan, you will need to complete the "Graduate Health Insurance Request Form" (located here: www.apu.edu/graduatecenter/download/) and submit it to the Graduate Center. If you have questions about enrolling, please contact the Graduate Center at 1-626-815-4570.
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.
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- Gallagher Student Health & Special Risk
500 Victory Road, Quincy, MA 02171
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