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Co-Op Health Plan (Domestic)
Winter 2021














Date of birth:
  

Gender














Opt-in

PLEASE ENROLL ME IN THE FOLLOWING: (to be eligible, all students must have current OHIP or equivalent coverage)

Winter Deadline: January 22, 2021 at 4:00 p.m.


I wish to apply for:
(Pick one of the plan options below)


I wish to apply for the Fanshawe Student Union Health Plan and agree to be bound by the benefit plan terms and conditions. Payment: After your form is processed, you will receive an email from ‘The Fanshawe Student Union’ to process your payment securely online through TD Merchant.



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