MNsure Account Request Form

This form is used to verify your identity so that you can create an online account on MNsure.org. 

Please only use this form if you are not able to create an account online.

Open the account request form

PDF Paper Forms

The online form requires you to enter your legal signature in writing using a computer mouse or touchpad device. If you would prefer to complete and mail us the paper form instead, download a form at one of the links below.

• Account Request Form (PDF) (English)
• Daim Ntawv Thov Tsim Tus Account (PDF) (Hmong)
• Foomka Codsiga Akoonka (PDF) (Somali)
• Formulario de solicitud de cuenta (PDF) (Spanish)
• Бланк запроса учётной записи (PDF) (Russian)
• Đơn Yêu Cầu Tài Khoản (PDF) (Vietnamese)