Request a Quote for Athletic Scholarships Injury Protection

Request a free quote for sports scholarship insurance to protect your scholarship opportunity. Practice, play, and compete in peace – fill out the form below to get started on comprehensive and customizable insurance.

Athletic Scholarships Insurance Form

Contact Name

Contact Mailing Address

Street Address

City

State

Zip Code

Phone Number

Insured First Name

Insured Middle Initial

Insured Last Name

Insured Address

Street Address

City

State

Zip Code

Insured Date Of Birth

Insured Gender

Male

Female

Insured High School Cohort/Period of Coverage

Senior 12 Month Period of Coverage

Junior 24 Month Period of Coverage

Type of Sport that is subject of Verbal Offer

Name of Institution of Higher Learning Making Verbal Offer

Details of Verbal Offer

DECLARATION FOR SUBMITTING

To the best of my knowledge and belief the information provided in this application, whether in my own hand or not, is true and I have not withheld any material facts. I understand that Non-disclosure or misinterpretation of a material fact will entitle the company to void the Insurance. I understand that submitting this Application does not bind me to complete the insurance but agree that should an insurance policy be issued, this Application and the statements made therein shall form basis of the insurance policy.

(By clicking “submit” below you are agreeing to the following statement)