Tuition Insurance Reimbursement Form

Phillips Theological Seminary has partnered with GradGuard to offer tuition insurance to students at a discounted rate to help them and their families overcome finanical loss of an unexpected withdrawal. Phillips is proud to offer a reimbursement program that offers to reimburse the cost of $1,500 of coverage. At the 1.1% cost of coverage, this equals $16.50 per student.

Reimbursement payments will be made after the close of the registration period for the semester selected, typically 2 weeks after classes begin.

First Name *

Last Name *

Phone *

Address *

Email *

What semester is this request for? *

How do you want to receive your reimbursement? *

I understand that reimbursement payments will be made at the close of the registration period. *

I agree

I understand that if I drop coverage before the end of the registration period, I am not entitled to any reimbursement. *

I agree

I understand that PTS only offers reimbursement of what I pay for coverage of $1,500, which at the current rate of 1.1%, equals $16.50. *

I agree

I understand that if I choose the EFT option, I am responsible for providing the correct and complete bank account information. *

I agree

Student's Signature *

clear