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Forms and Applications

Enrollment Forms and Applications

2014-2015 APU Student Enrollment Form--Artist Certificate Program.pdf

2014-2015 APU Dependent Enrollment Form--Artist Certificate Program.pdf

2014-2015 APU Dependent Enrollment Form - Voluntary.pdf

Change of Name Request Form.pdf

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.

If you are a VOLUNTARY GRADUATE student please fill out the paper form. If you are a HARD WAIVER DOMESTIC UNDERGRADUATE, INTERNATIONAL STUDENT, OR VISITING FACULTY AND SCHOLAR student please enroll dependents electronically after logging in.


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
    617-769-6050
  • Toll Free
    800-406-4517
  • Fax
    617-479-0860
  • Email
    apustudent@gallagherstudent.com