Forms

The following files are in PDF format:

  • Midyear Enrollment form : Used to enroll during our open enrollment period which is in December and January of every academic year. (*form will be up December 1, 2022)
  • UHCS Access Request Form : This form is to be used by Graduate and CPS students that waive from NUSHP, but would like to have access to the University‚Äôs Health and Counseling Services.
  • Mid Year Adjustment Form : This form is to end coverage of NUSHP. (*Only for students who who Graduate in December or Exchange students: form will be up December 1, 2022)
  • Petition to Enroll NUSHP – Student Only : Use this form is if you have had a qualifying event and are in need of insurance.
  • Petition to Add Dependents : If you are already enrolled in NUSHP, but need to add a dependent.

 

Other Forms

The following files are in PDF format: