Logo Intern Program

If you have not already submitted your information to the PIIAI you may do so by filling out the form below. Agencies will then be able to contact you directly to set up interviews.  Your information will be posted on our website for the agencies to view.

Fields with an asterisk (*) are required.

Contact Name: *
Address: *
(Use the address you will be located at in the summer of 2006)
City: *
State: *
Zip: *
E-Mail: *
Phone: *
(Use the phone number where you can be reached prior to May)
College:
Year of Graduation:
Major:
    
Professional Independent Insurance Agents of Illinois
4360 Wabash Ave. • Springfield, Illinois 62711 • Ph: (800) 628-6436 • Fax: (217) 793-6744
Contact Shannon Churchill at (800) 628-6436, ext. 3004 or schurchill@piiai.org with questions.