1st Agency: Student Health Request for Information
Check all applicable. Please include a brochure of your present Student Health Plan.
Indicate rates charged for the current and past three years.
Based on your current plan, would you like additional quotes to increase, decrease or add specific benefits, i.e. Room & Board, Mental & Nervous? If so, please specify.
5071 WEST H AVENUE | KALAMAZOO, MI 49009