Treasurer's Office Other Insurance-Related Request Form

Treasurer's Office
Other Insurance-Related Question/Request Form

Guidance and information

Please review the General Insurance Information for answers to frequently asked questions before proceeding with submitting a question/request.

I have reviewed the resources provided in the "General Insurance Information" section link provided above and still need additional assistance (this checkbox is required in order to proceed with submitting a question)

Request information

What are the details of your question or request? (required)

Do you have attachments? (required)

(Please provide any documentation that would be necessary to process your request. The faster we get what's needed to process your request, the faster it will be resolved.)

Attachment (required)

Additional attachment 1 (required)

Additional attachment 2 (required)

Additional attachment 3 (required)

Please provide your contact information so we can respond!

Name (required)

(first last)

Email (required)

(if you are a student, student-employee or an employee, use only your University of Massachusetts email address)

Campus (required)

Treasurer's Office Other Insurance-Related Request Form

Treasurer's OfficeOther Insurance-Related Question/Request Form

Please provide your contact information so we can respond!

Treasurer's Office
Other Insurance-Related Question/Request Form