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Self Enrollment

1. Agreement
2. Select Sponsor
3. Review Plan
4. Privacy Consent
5. Personal Data
6. Payment
7. Confirmation
Agreement

I understand that in order to be eligible for this Group insurance, all of the following statements about myself must be true:

  • I am approved to enroll into the group insurance plan which my university/company/program has in place with CISI.
  • I certify that the personal information, which I will provide on the application that follows, will be truthful and accurate.

I understand that in order to be eligible for this Group insurance, all of the following statements about myself must be true:

  • I am a University of Washington student engaged in educational activities abroad including study, research internships and/or community engagement.
  • I am approved to enroll in the group insurance plan by University of Washington.
  • I certify that the personal information, which I will provide on the application that follows, will be truthful and accurate.
Next

Have a Question?

Claims or benefits:
inquiries@mycisi.com
Enrollment:
enrollments@ culturalinsurance.com
(800) 303-8120 or
(203) 399-5130

Sponsor Code

Please contact your international education program if you do not know your Sponsor's code.

Coverage Start Date

The earliest your coverage can begin is two days from now. You may purchase coverage for additional days before and /or after the actual dates of your international program, but the total number of additional days may not exceed 30.

Coverage End Date

The last day on which you will need coverage. You may purchase coverage for additional days before and/or after the actual dates of your international program, but the total number of additional days may not exceed 30.

Program Name

If your sponsor has given your trip a program name, please enter it here

ID/Number

If your sponsor has assigned their own ID/Number to you, please enter it here (this is different from the CISI participant ID that will be assigned to you at the conclusion of this enrollment process).

UW Student Number

Please enter university assigned UW Student Number here. This is a required field and must match your UW Student Number.

Email Address

Please provide a valid email address to which we can send your confirmation policy materials.

Email Address

Please provide a valid UW email address. Email must end in @uw.edu

Credit Card Number

Please provide your credit card number. We accept Visa, MasterCard and American Express.

Credit Card Expiration Date

Please indicate the expiration month and year of the credit card in the fields below.

Study Abroad Location

Country to which you will be traveling.

If you are travelling to more than one country, please select "WW - Worldwide" as your location.

Same as contact address

Check this box if your billing address is the same as your previously-entered US mailing address.