Tuition Protection Claim Form
Submit your tuition protection claim using this streamlined form. Please complete all required fields to ensure timely processing.
Claimant’s Full Name
*
First Name
Last Name
Email Address
*
example@example.com
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Student Name
*
First Name
Last Name
Institution / School Name
*
Program or Course Name
*
Claim Type
*
Please Select
Withdrawal due to illness
Withdrawal due to family emergency
Institution closure
Other
Date of Tuition Payment or Enrollment
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Claim Amount Requested (USD)
*
Supporting Documentation Upload
*
Upload a File
Drag and drop files here
Choose a file
Cancel
of
Detailed Claim Description / Explanation
*
Submit Claim
Should be Empty: