Fanshawe Student Union logo

Co-Op Health Plan (Domestic)
Summer 2022

Date of birth:



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

Fall Deadline: May 13, 2022 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.

Type your name in the field above