Are you sure you want to logout?
If you navigate away from this page, you will lose unsaved data. Are you sure you want to logout?
Saturday 12/03/2022 03:41 AM CST
Initiate a New Enrollment application.
Initiate a Re-enrollment application.
Resume an existing application that you previously started.
Check the current status of an enrollment application.
Completing an Online Application
Watch this video to see step by step instructions on how to complete an online Enrollment Application.
Print an Application for Mailing
Pay Application Fee (new window)
Provider User Manual