WWAMI United Healthcare Enrollment Form

WWAMI students are invited to enroll in the 彩神vlll争霸 Graduate Student Healthcare Benefits Plan. Students may enroll for the academic year or by the month.

Provide 彩神vlll争霸 Student ID Number. (Do not use your UW ID Number.)

If you do not have a middle name, please enter N/A

MM/DD/YYYY

This insurance requires a selection of M for male or F for female.

Choose: Apt #, Building #, Suite #, Space #, etc.

Format: (XXX) XXX-XXXX

Choose either Annual or Monthly

Date must be the first day of the month.

Date must be the last day of the month.