APPLICATION FOR TUITION INSURANCE PROPOSAL

APPLICATION FOR TUITION INSURANCE PROPOSAL

"*" indicates required fields

Information About Your School

Address
Type of School
Date of Your Classes Opening
Date of Your Classes Closing

Applicable Tuition/Fees:

do not include financial aid

Number of Students:

Your Tuition Refund Practices:

Do you have a written procedure to handle tuition refunds?
What is your current tuition Insurance plan design?

Desired Coverages. The following causes of loss may be covered. Indicate a percentage of payment (from 0% to 100%):

Would you like to include tuition continuance coverage. This coverage allows for a student to have an approved claim paid for the death of a tuition payer or job loss of a tuition payer without having to withdraw from school. Without this endorsement a student has to withdraw from school for coverage to potentially apply.
Would you like to include tuition continuance coverage. This coverage allows for a student to have an approved claim paid for the death of a tuition payer or job loss of a tuition payer without having to withdraw from school. Without this endorsement a student has to withdraw from school for coverage to potentially apply.
*specimen of your current enrollment contract
Max. file size: 100 MB.

Your Discharge and Withdrawal History (by Academic Year)- MONTHS LOST FOR ALL STUDENTS ENROLLED IN THE SCHOOL

Most Recent Completed School Year:

do not use current school year if it is in progress

Second Most Recent Completed School Year:

Third Most Recent Completed School Year:

Person Completing Application:

Name
What does 4 + 6 equal?
This field is for validation purposes and should be left unchanged.