Diversity Exam Reimbursement Program Application

The Society of Actuaries/Casualty Actuarial Society Course Diversity Exam Reimbursement Program is available to the following groups that are under-represented in the actuarial profession: African American, Hispanics, and Native North Americans. An applicant must be either a U.S. citizen or have a permanent resident visa. This reimbursement program is not designed for individuals employed full-time in an actuarial position.

Date:

Exam Passed

1(P)
2 (FM)

Minority Group:

Last Name:

First Name:

Middle Name:

Address:

City:

State/
Canadian Province:

Zip/Postal Code:

Country:

Phone:

E-mail:

Are you a Student or Career Changer?

Student
Career Changer

If student, where do you attend school?
What is your major?

What is your highest level of education achievement?
If you have earned a college degree, please specify:
School(s):
Degree(s):
Major(s):

Are you employed?
If you are employed, what is the nature of your work?

Are you a U.S. Citizen?	Yes No
If no, what type of visa do you have?
If no, what is your place of birth?

Have you sat for Exam 1 (P) before?	Yes No
If yes, how many times?

Would you like to be put in contact with a memeber of the Joint Committee on Minority Recruiting?

Yes
No

Optional Information

Gender:
Date of Birth: