Student Professional Liability Insurance Program

Request for Insurance from SPLIP

Use this form to request evidence of insurance for students in internships in Health Care (Nursing, PT, etc.), Social Work, and Education (student teaching, counseling, etc.).

This insurance does not cover worker’s compensation or transportation exposure and is not a health insurance policy.

Students already covered through SPLIP do not need to be covered by SAFECLIP.

Requster Information



Insurance Information

Certificate Holder Information


Please double check your information before hitting submit