Return to Online Enrollment Form
If you have any questions or problems while completing this form, please call us 877-919-PASC Monday-Friday between 8:00am and 6:00pm. We will gladly help you troubleshoot, take your information by phone, or send you a packet by mail.
Once logged in, you can edit a saved but unsubmitted application, view a submitted application, or create a new application by clicking on the "Create" button. Be sure to hit "Submit" to ensure we have received your information.
An Enrollment Advisor will contact you shortly after you submit the form to go through additional enrollment questions with you and to discuss the next steps in the enrollment process.
You will need Internet Explorer 7 or higher, Firefox 3 or Safari 4 to access this application. If you need to download the correct version, click the appropriate link below.
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