Request for Program Insurance

Information on the Program

Name of Activity, Event, or Program *This question is required. If your unit will be hosting similar activities, events, or programs, be sure to name them differently.

Sponsoring Unit or Department *This question is required.

Choose the type of activities that will be taking place. *This question is required.

Dates of Activity *This question is required. Single day or consecutive dates for activities enter as mm/dd/yy or mm/dd/yy - mm/dd/yy
Non-consecutive dates for activities enter as mm/dd/yy, mm/dd/yy and mm/dd/yy

Estimated Number of Participants *This question is required. This question requires a valid number format.

Budget Number *This question is required.

Activity Code (if applicable)

Would you like to add another program? *This question is required.

Request for Program Insurance - Update

Information on the Program