FLHCC Diabetes Project
Members of Independent Colleges and
University Benefits Association (ICUBA)
 
Enrollment Forms and Surveys
 
 
The enrollment period for this project will end on March 4, 2016. You must complete BOTH the 3 forms and the 3 surveys below.
 
Forms 
 
To download all forms required, in one file, please select your preferred language below.  Make sure your name and organization are listed on all your forms.  
Please note:  only the consent form has been translated. 
 
Please email all forms to DiabetesProject@FLHCC.ORG 
 
 
 
 
If individual forms are needed, please click below. 
 
 

Please note, you cannot save any information on the forms on the website. You will have to download the form, save it on your local computer, complete the form, and email them to DiabetesProject@FLHCC.ORG.  Make sure your name and organization are listed on all your forms.

Survey 

For the surveys, please do your best to complete them online using the links provided below. 
 
 
 
 
If you cannot complete the surveys on line, please click the link below to download the surveys to complete.
 
 
Please note, you cannot save any information on the forms on the website. You will have to download the form, save it on your local computer, complete the form, and email them to DiabetesProject@FLHCC.ORG. Make sure your name and organization are listed on all your forms. 
 
 

Updated 3/7/2016

ICUBA Enrollment Forms