Actuarial Exam Support Program Application Form – Casualty Actuarial Society Exams and Courses

Given/Legal First Name(Required)

Middle Name

Given/Legal Last Name(Required)

Do you reside within the United States or Canada?(Required)

United States of America

Canada

Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Phone Number(Required)

Email(Required)

Date of Birth(Required)

Please note that this program is intended for current students or those not employed in a full-time actuarial position. Select the one that best applies to you.(Required)

Student

Not employed in a full-time actuarial position

None of the above

I am requesting (check all that apply):(Required)

Exam Fee Reimbursement

Study Material Stipend

Exam passed or given a score of 4 or 5.(Required)

*Please note that each person is only eligible for up to one reimbursement per DISC Online Course and it is for passing scores only, at the 50% discounted rate.

Date exam was taken*:(Required)

*Please note that only exams taken on January 1, 2024, or later are eligible for this program.

Date score was received*:(Required)

*Please note that all applications must be submitted within 12 months of receiving your score.

Score received(Required)

Only scores of 4 or higher for CAS exams, or passing scores for DISC courses, are eligible for reimbursement.

If you are a student, through which of the following criteria are you eligible for this program? Select all that apply.(Required)

*First generation in family to attend college means your parents, step-parents, or primary caregivers did not attend college or university.

Please provide a brief description. Reimbursement for those selecting only this criterion may be subject to review and approval.(Required)

If you are currently not employed in a full-time actuarial position, through which of the following criteria are you eligible for this program? Select all that apply.(Required)

I qualified for federal or state Student Loan Forgiveness.

My income is below the living wage requirement, based on my location and number of family members in my household, as shown in the MIT Living Wage Calculator.

I qualify for SNAP or other state food assistance programs.

I have received unemployment benefits in the last 12 months.

I have received a grant through the Workforce Innovation and Opportunity Act (WIOA) Workforce Programs in the last 12 months.

I am part of the first generation* in my family to graduate from a two-year or four-year college or university.

I am a military veteran.

I speak English as a second language (unless you are of French-Canadian origin).

I have other circumstances or barriers. Including those beyond financial need.

*First generation in family to attend college means your parents, step-parents, or primary caregivers did not attend college or university.

Please provide a brief description. Reimbursement for those selecting only this criterion may be subject to review and approval.(Required)

Please specify your gender identity. Your answer to this question will not impact your eligibility for the reimbursement or stipend.(Required)

Man

Woman

Nonbinary or third gender

Not listed

I prefer not to answer

Please indicate your race and ethnicity. Your answer to this question will not impact your eligibility for the reimbursement or stipend.(Required)

American Indian or Alaska Native

Asian

Black or African American

Hispanic, Latino, or Spanish origin

Native Hawaiian or Pacific Islander

White or Caucasian (non-Hispanic)

Other

I prefer not to answer

Do you have plans to sit for another exam in the future?(Required)

Yes

Exam Reimbursement Agreement

Submitting this form for exam reimbursement means that you agree with the following:

Reimbursement requests are processed on a monthly basis. Up to 35 exam reimbursements and 25 study material stipends will be disbursed each month on a first-come, first-served basis. Any applications received after the monthly cap has been reached will be rolled over to the following month in the order the application was received. If the monthly cap is not reached in a given month, the remaining reimbursements will be added to the pool of reimbursements for the following month.

Any evidence of fraud may result in consequences such as suspension from exam services, notification of university program, employer, or other actions as deemed appropriate.

To the best of your knowledge, you have provided complete and truthful information.
You have not been reimbursed for this exam from any other source.
If you selected to receive a study materials stipend above, please confirm that you are not applying for a stipend for the same exam from another source.
Please note that actuarial candidates are bound by the Code of Professional Ethics for Candidates.

It is important that actuarial candidates understand and apply this code. In particular, rules one and two apply here.

RULE 1: An actuarial candidate shall act honestly, with integrity and competence, to uphold the reputation of the actuarial profession.

RULE 2: An actuarial candidate shall not engage in any professional conduct involving dishonesty, fraud, deceit, or misrepresentation to commit any act that reflects adversely on the actuarial profession.

Agreement Checkbox(Required)

I have thoroughly read the exam reimbursement agreement and agree.