Eligible Dependent Question Title * 1. Legal Guardian or Parent Name OK Question Title * 2. Email OK Question Title * 3. Ball State Affiliation Alumni Faculty/Staff Student Non-Affiliated/Community Member Dependent/Spouse of an Affiliate Retired OK Question Title * 4. Child 1 Full Name OK Question Title * 5. Child 1 Birth Date Date / Time Date OK Question Title * 6. Child 2 Full Name OK Question Title * 7. Child 2 Birth Date Date / Time Date OK Question Title * 8. Child 3 Full Name OK Question Title * 9. Child 3 Birth Date Date / Time Date OK Question Title * 10. Child 4 Full Name OK Question Title * 11. Child 4 Birth Date Date / Time Date OK Question Title * 12. Are all of the children listed above your legal dependents? The affiliated rate is only applicable to legal dependents of Ball State affiliates. If no, then please list which children are not your legal dependents. Yes No Other (please specify) OK DONE