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USE BLACK INK ONLY. PLEASE PRINT. For address and/or primary care physician changes call (518) 641-3700, 1-800-777-2273, or visit www.cdphp.com Enrollment Application/Change Form EMPLOYER USE ONLY
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How to fill out enrollment form - Bethlehem:

01
Start by carefully reading the instructions provided with the enrollment form. Make sure you understand all the requirements and any specific information needed.
02
Begin by writing your personal information accurately in the designated spaces. This typically includes your full name, date of birth, address, and contact information.
03
Provide any additional details required, such as your social security number, citizenship status, or emergency contact information. Be sure to double-check the accuracy of these details before proceeding.
04
If applicable, indicate any previous educational institutions you have attended. Include the names of schools, years attended, and any degrees or diplomas earned.
05
Follow the instructions for providing information about your academic interests or intended major, if applicable. This may involve selecting certain courses or programs offered by the institution.
06
If required, provide details about any financial aid or scholarships you are applying for. This usually includes information about your family's income, assets, and expenses.
07
Review the completed enrollment form for any errors or omissions. It is crucial to ensure all provided information is accurate and up-to-date.
08
Sign the form at the designated area, following any additional instructions regarding signatures or dates.
09
Prepare any necessary supporting documents or materials to be submitted along with the enrollment form, such as transcripts, letters of recommendation, or identification documents.
10
Finally, submit the completed enrollment form and all supporting documents according to the provided instructions. Make a copy of the form for your records.

Who needs enrollment form - Bethlehem?

01
High school seniors who are applying to colleges or universities in Bethlehem.
02
Transfer students from other educational institutions who wish to enroll in a Bethlehem-based institution.
03
Non-traditional students who are looking to further their education and need to complete an enrollment form for admission into Bethlehem-based educational institutions.
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Enrollment form - bethlehem is a form that needs to be filled out by individuals or organizations who wish to enroll in a specific program or service provided by the city of Bethlehem.
Any individual or organization who wants to enroll in a program or service provided by the city of Bethlehem is required to file the enrollment form.
To fill out the enrollment form - bethlehem, you need to provide accurate information about yourself or your organization, including contact details and any other required information related to the program or service.
The purpose of enrollment form - bethlehem is to collect necessary information from individuals or organizations who wish to enroll in a specific program or service provided by the city of Bethlehem.
The enrollment form - bethlehem may require information such as name, address, contact details, program or service of interest, and any other specific requirements set by the city of Bethlehem.
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