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HUSKY, Healthcare for UninSured Kids and Youth


HUSKY Application


You can enroll in the HUSKY program by downloading the HUSKY Application Form, completing it and mailing it to the address on the form.

Download Acrobat for FREE! Abode PDF Icon Note: The following file is available in Adobe Acrobat format to download. The Acrobat PDF format makes the application very easy to print and and fill out off-line. If you don't have the Adobe Acrobat reader, click on the yellow button to download it for FREE.

Download IconDownload the HUSKY Application Instruction Form Download IconDownload the HUSKY Application Form  

Download Icon
Oprima para descargar la solicitud de HUSKY y las instrucciones para solicitar (pdf 1247KB)

For the visually challenged users, Adobe provides an Acrobat Plug-in for interpreting documents written in pdf format.

[Windows Platform] [DOS Platform] [Macintosh Platform]



If you have problems downloading the application form, or you do not have Adobe Acrobat Reader you can call:

1-877-CT-HUSKY (1-877-284-8759) to:
*Learn more about HUSKY
*Receive an application

 

1-800-656-6684 to:
*To apply by phone

HUSKY customer service representatives will help you with the application process.

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Date Last Modified: Wednesday, January 02, 2008