WSIA Scholarship Application Please enable JavaScript in your browser to complete this form.Please enable JavaScript in your browser to complete this form.Name *FirstLastEmail *Brokerage/Firm *Title *Description of Present Job Responsibilities (job description): *Insurance Employment History (brief description): *Preferred Educational Program (Select One): *Excess & Surplus Lines | June 15-18, 2025 | Chicago, ILMarcus Payne Advanced E&S | June 15-18, 2025 | Chicago, ILUnderwriting Bootcamp | October 6-9, 2025 | Scottsdale, AZWSIA University | November 12-15, 2025 | Orlando, FLWhy do you want to attend the scholarship you’ve selected? Why do you think you should be selected? *Are you a licensed Surplus Line Broker? *YesNo*If no, are you interested in obtaining your Surplus Line Broker License? YesNoSubmit
