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

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* 1. Address

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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

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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
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