Health or Dental Insurance Changes
Forward completed forms below to:
ETSU Quillen College of Medicine Office of Graduate Medical Education
Box 70415
Attn: Mrs. Sissy Shipley
Johnson City, TN 37614 or call (423) 439-6373
Please do not send forms directly to insurance companies, or to the ETSU HR Deparmtent
on campus.
ALL insurance forms must be processed through the GME office.
BlueCross BlueShield Insurance Change Form 401k Forms
Please contact Sissy Shipley (423) 439-6373 in the GME office to obtain a form for name, address or phone number change. The form can then be submitted to her at: shipley@etsu.edu.
Additional Forms & Information
- Change of Name Request on Official University Documents
- Educational Commission For Foreign Medical Graduates (ECFMG)
- Public Service Loan Forgiveness
- Resident Emergency Loan Fund Application
- Tennessee for Health Workforce Development Residency Incentive Program
- Tennessee Medical Association Website
- Tennessee Medical Foundation Website