New York State Public Schools Trust

New York State Public Schools Trust

Member Resources

Request a Quote

New York State Public Schools
Workers' Compensation Trust

Application for Quote

* Your Name:
* Your Organization:
* Your Email:
* Your Phone:

School District Information

School District:
Address:
City:
Zip:
County:
Federal Tax ID:

School Business Official

Official Name:
Title:
Email:
Phone:

Underwriting Information

Requested Effective Date of Coverage:

Number of Employees

Full-Time:
Part-Time:
Seasonal:
Volunteers:

Payroll

Code 8868:	$ (Professional, Admin, Clerical, etc.)
Code 9101:	$ (Custodial, Cafeteria, Transportation, etc.)
Sum:	$

Experience Modification Factor

After submitting this form, you will receive a printable copy of your application in an email from underwriting@publicschoolstrust.org.

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