Health Insurance Status Form
There are many children in New York City that do not have health insurance coverage.  Almost all children up to the age of 18 are eligible for public health insurance for free or at low cost yo you, regardless of immigration status.

The New York City Department of Education's Office of School Health is working to provide access to public health insurance for all students and their families.  In order to ensure that every child has health insurance coverage, each school has been assigned a health insurance en-roller.

Please complete the information below for your child.
Sign in to Google to save your progress. Learn more
Student's First Name *
Student's Last Name *
OSIS # *
Does your child need health insurance? *
Required
(If No, please check the appropriate box)  My child has:
Would you like a health insurance counselor to call you?
Submit
Clear form
Never submit passwords through Google Forms.
This form was created inside of NYC Department of Education. Report Abuse