Continuing Student Registration Verification

Use this form as an easy way to update information on your student registration status.

Print this page and present it to the registrar of the school, college, university or technical school you are attending.  Ask them to complete the information requested and return to Graphic Arts Benefit Corporation at the address noted.  We'll update our files so that any future claims can be considered without delay.

In the future, contact our office if you need cards to provide ongoing information for our files.

Thank you for your assistance.

To be completed by the GABC participant:

Name of Insured:

I.D. No.:

Name of Student:

Name of School:

Class Standing:
(Fresh/Soph/Jun/Senior)

Expected Day of Graduation (MM/DD/YY):

Don’t forget to print this form and have the registrar’s office complete the bottom, then mail it to:

Graphic Arts Benefit Corporation
6411 Ivy Lane, Suite 700
Greenbelt, MD 20770-1411

To be completed by the registrar:

I hereby certify that the above-named student is enrolled for a total of ______credit hours for the  ___________, 20____ semester/trimester/term (circle one) and that this constitutes full-time status/part-time status (circle one) in accordance with the guidelines established by  _______________________________________(name of school).

Signed:

Dated:

Title:

Phone No.: