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University of Maryland,  Baltimore

Forms and Applications

Enrollment Forms and Applications

Accident Only Plan - Instructions for submitting claims for reimbursement.pdf

Accident Insurance Claim Form.pdf

Change of Name Request Form.pdf

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
  • Fax