Health and Dental Opt-In Form

1. Contact InformationPerson Opting-In to the Health and Dental Plan

First Name *This question is required.

Last Name *This question is required.

Student Number *This question is required.

Characters used: 0 out of 9.

Characters used: 0 (minimum 9).

Street Address *This question is required.

Apt/Suite/Office

City *This question is required.

Postal Code *This question is required.

Country *This question is required.

Email Address *This question is required. This question requires a valid email address.

Phone Number *This question is required.

Birthdate (yyyymmdd) *This question is required. This question requires a valid number format.

Characters used: 0 out of 8.

2. I am opting into the following plan year *This question is required.

Please select the addition of either "one family member" or "more than one family member" in the question above.

Warning

Kamloops campus students enrolled in at least 9 credits in the Fall Semester (three courses) will be automatically enrolled in the TRUSU Health and Dental Plan (unless you have previously opted out). Opting in using this form will cause you to be charged twice. This form is intended for part-time students, open learning students, students looking to add family members, or students who have previously opted out of the Health Plan.

If you believe that you should be on the Health Plan and a charge has not appeared on your account please contact the Services Coordinator via email at services@trusu.ca.