Student Teacher Liability Insurance Application
Student Teachers Federation Membership

AFT New Mexico | 530 Jefferson St. NE. Albuquerque, NM 87198 | 505-266-6638 |

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* 1. Address

Name

Address

Address 2

City/Town

State/Province

ZIP/Postal Code

Email Address

Phone Number

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* 2. Higher Education Institution (you are completing your student teaching through | i.e. UNM, NMSU, NMHU, etc):

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* 3. Approximate Start Date (when will you begin your student teaching):

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* 4. Years of Coverage

1 year = $20.00

2 year = $25.00

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* 5. Application Completion Date:

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* 6. Signature:

By entering your full name in the box above, you affirm that the information entered above is complete and accurate so that your liability insurance application may be processed correctly.

Please make sure to submit your payment so that your liability insurance may be fully processed so that you will be fully covered once your student teaching begins. You can submit your payment by visiting the following link: https://bit.ly/3ls4e4T

Student Teacher Liability Insurance Application Student Teachers Federation Membership

Question Title

* 1. Address

Question Title

* 2. Higher Education Institution (you are completing your student teaching through | i.e. UNM, NMSU, NMHU, etc):

Question Title

* 3. Approximate Start Date (when will you begin your student teaching):

Question Title

* 4. Years of Coverage

Question Title

* 5. Application Completion Date:

Question Title

* 6. Signature:

Student Teacher Liability Insurance Application
Student Teachers Federation Membership