Fall 2006
064
CampusCare Enrollment Form

Name
Date of Birth Student I.D.#
Permanent Address
City State
Home Phone Zip
Signature Date
Fall coverage period: August 14 through December 31

I wish to enroll in CampusCare at a cost of $80 per semester in order to obtain the most cost effective outpatient health care at the Campus Health Service. After reviewing the benefits, I understand that CampusCare covers most expenses for services provided within Campus Health as long as the diagnostic work up is initiated at the Campus Health Service.

Coverage period: August 14, 2006 through December 31, 2006

Last day to enroll: September 5, 2006

Mail, fax or bring to:

Campus Health Service(Insurance Office)
University of Arizona
P.O. Box 210095
Tucson AZ 85721-0095

For more information call us at:

  • Phone:(520) 621-5002
  • Fax:(520) 626-8616

You may choose to pay by check made payable to the Campus Health Service, or have the charge posted to your University of Arizona Bursar student account.