Appendix H: Insurance Agreement

STUDENT INSURANCE AGREEMENT

I, ____________________________________________, understand that professional liability insurance for student nurses is provided for me through the College’s general insurance policy maintained with the Missouri United School Insurance Council and have received a description of that coverage.

The insurance is provided to me at no charge and is limited to coverage as specified in the M.U.S.I.C. insurance policy. The coverage does not preclude me from obtaining additional coverage that I may desire.

Date: ___________________________________________________

Printed Name: ____________________________________________

Student Signature: _________________________________________