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MEDICARE OPEN ENROLLMENT October 15th to December 7th Once Completed, Return This Form To: East Alabama Regional Planning Commission, SHIP, P. O. Box 2186, Anniston, AL 36202Name:Date of Birth:Address:City:State:Zip:Phone:
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Obtain the pre-enrollment form from the institution or organization providing the service.
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Anyone who is looking to enroll in a program or service provided by an institution or organization may need to fill out a pre-enrollment form. This form is typically required to gather necessary information and to initiate the enrollment process.

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The pre-enrollment form is a document required for individuals or entities to indicate their intent to enroll in a specific program, service, or institution, typically before the formal enrollment process.
Individuals or entities intending to enroll in the program or service for which the pre-enrollment form is applicable are required to file it.
To fill out the pre-enrollment form, individuals should provide all required personal or organizational information, answer specific eligibility questions, and submit any necessary supporting documents as instructed.
The purpose of the pre-enrollment form is to gather preliminary information that helps assess eligibility and prepare for the subsequent enrollment process.
The pre-enrollment form typically requires personal details such as name, contact information, demographic information, and any necessary identification or reference numbers depending on the specific program.
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