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):

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* 3. Approximate Start Date:

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* 4. Years of Coverage

1 year = $20.00

2 year = $25.00

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* 5. 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.

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):

Question Title

* 3. Approximate Start Date:

Question Title

* 4. Years of Coverage

Question Title

* 5. Date:

Question Title

* 6. Signature:

Student Teacher Liability Insurance Application
Student Teachers Federation Membership