Request for Coverage Quote

Optional Coverage requests can be submitted on behalf of a Department, College or major unit. No Coverage will be considered bound and in force until accepted by the University's insurers. This form can be used to initiate the coverage request, however, because premiums are charged back to your Department and College, an actual written application must be completed and approved by your Dean and/or Director. Please allow 20-30 days for coverage to be placed.

[Form will go here]