CISR Scholarship

CISR Scholarship Application

This form may be used to nominate someone or to personally apply for a Certified Insurance Service Representative Scholarship for an Illinois-sponsored institute (Value - $100.00).

Selection of the winner(s) will be made by the Illinois Education Committee based on all materials and information submitted with this application. Please be complete - tell us all you can about the applicant or yourself.

The following must apply to the applicant to qualify:

Applicant must be a full-time insurance professional who has been in the insurance business for at least one year and currentlly employed by a member agency or company of PIIAI.
Applicant must have demonstrated an interest in and commitment to professional continuing insurance education.
Applicant must have never been a CISR, either now or in the past.
Applicant must not have previously completed more than one CISR Seminar.

* - items in red are required.

Name:
Agency/Company:
Address:
City:
State:
Zip:
Phone:
Fax:
E-Mail Address
How long in the insurance business?
Do you hold any insurance professional designations?	Yes No
If yes, which?
List any professional organizations you belong to:
Provide a brief description of your work experiences, commitment to personal advancement, or other reasons for consideration.

For a printed copy, click here.(Word Format)
Questions? Contact Sandy Cuffle at (800) 628-6436, ext. 3007 or (217) 321-3007.
To return to the Education Page, click here.