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Community Health Choice P.O. Box 301413 Houston, TX 77230 Toll-free: (833) 2768306 TTY: 711 Local: (713) 2955007 www.communityhealthchoice.orgIf you request disenrollment, you must continue to get
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How to fill out disenrollment form - community

01
To fill out a disenrollment form for the community, follow these steps:
02
Obtain the disenrollment form from the community center or download it from their website.
03
Read the form carefully to understand the requirements and instructions.
04
Fill in your personal information accurately, including your full name, address, phone number, and any other required details.
05
Provide the reason for disenrollment in the designated section, clearly stating the reasons for your decision.
06
Attach any necessary supporting documents, such as proof of residency or identification.
07
Double-check all the information you have entered to ensure it is accurate and complete.
08
Sign and date the form at the bottom to confirm your request for disenrollment.
09
Submit the completed form either in person at the community center or through a designated submission method as specified.
10
Keep a copy of the filled-out form for your records.
11
Follow up with the community center in case of any additional requirements or if you have not received a confirmation of your disenrollment.

Who needs disenrollment form - community?

01
Anyone in the community who wishes to discontinue their membership, affiliation, or involvement may need a disenrollment form. This may include individuals who have moved out of the community, no longer wish to participate in community activities, or have found alternative affiliations. The disenrollment form allows these individuals to formally request the termination of their community ties and discontinue any associated obligations or responsibilities.
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Disenrollment form - community is a form used to officially remove a member from a community.
All members who wish to leave the community are required to file a disenrollment form.
To fill out the disenrollment form - community, members must provide their personal information and the reason for wanting to leave the community.
The purpose of the disenrollment form - community is to officially document and process the removal of a member from the community.
The disenrollment form - community must include the member's name, contact information, reason for disenrollment, and any supporting documentation.
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