Enrollment Close Out Report Enrollment Close-Out Report Enroller Info* First Last Company Name*Travel About how many miles did you travel?*No Travel RequiredLess than 5050-100100-200200+Attach Google Maps Screenshot Drop files here or Did you incur lodging expenses?*YesNoAttach Lodging Receipts Drop files here or Did you incur airline expenses?*YesNoAttach Airline Receipts Drop files here or Enrollment Details How many days did you enroll?*1/212345678910More than 10Please list the # of days you enrolled w/ details:*Type of EnrollmentLocation(s)# of Hrs# of EE's EnrolledDate of Enrollment Face to FaceTelephonicPresentations Only Did you collect any paper applications or service forms for this enrollment?*YesNoHow many were collected & any details needed here:Please bring in or email paper applications to firstname.lastname@example.org for carrier submission. By checking this box, I have confirmed that I synced the core enrollment system.* Confirmed! By checking this box, I have confirmed that I synced the worksite enrollment system.* Confirmed!