01. Edit your enrollment information form online
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02. Sign it in a few clicks
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03. Share your form with others
Send member enrollment form via email, link, or fax. You can also download it, export it or print it out.
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- Click ‘Get Form’ to open it in the editor.
- Begin by entering the Deceased Consumer’s Information. Fill in the First Name, Last Name, Middle Initial, Address, City/State, Zip Code, Date of Birth, and Date of Death as indicated on the Covered California Account.
- Next, provide your Reporting Member’s Information. Ensure you include your Last Name, First Name, Middle Initial, Address, City/State, Zip Code, Daytime Phone Number (this is required), and Email Address.
- Indicate your relationship to the deceased and answer whether you need a copy of the previous year’s IRS form 1095A. If applicable, specify if the address on the account needs updating and provide the new address.
- Attach a copy of your identifying information. If no document is attached, ensure your signature is notarized.
- Finally, sign and date the form at the bottom to confirm that all information provided is true and correct.
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NECC now offers students this option to submit financial aid documents online, safely and securely. Documents will no longer be accepted via email.
May 12, 2026 Follow this pattern to notify people when their online form submission is in progress, when we receive their submitted form, and when a system error has causedRead more