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YPC Scholarship Form
  1. Attending college for insurance or a related field of study? If so, could you use up to $2,000?

    YPC College Scholarship Application Process:

    • - Must be sponsored by an active PIA Member *There is NO obligation to purchase insurance from your sponsor. In advance of submitting this application visit the PIAW website to find a PIAW member in your area who would be willing to sponsor you: www.piaw.org - membership/find a member. Make contact and request a sponsorship.
    • - Ask your sponsor to prepare a referral paragraph (750 characters, with spaces, or less) in plain text. You will copy and paste this onto the website scholarship form.
    • - Have your sponsor information available – name, address, phone, email.
    • - Prepare your document on “Tell us your post graduation career plans.” (1500 characters, with spaces, or less) to copy and paste onto the website application.
    • - You are now ready to begin the online application. 

    Recipients will be notified by email.

    The PIA of Wisconsin’s Young Professionals Club wishes to award:
    Up to $25,000 in scholarships! Scholarships are solely based on sponsorship participation.

    To be considered for the scholarship, please submit this form by February 15, 2018.

  2. Please select your application type(*)

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  1. Please give us some information about the Student.
  2. Student Name
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  3. Student Address
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  4. Student City
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  5. Student State
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  6. Student Zip
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  7. Student Phone
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  8. College or University registered at
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  9. Education Level(*)
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    (i.e. college freshman, college senior, high school senior, etc.)
  10. Field of Study
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  11. GPA (transcrips required if scholarship is granted.)(*)
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  12. Student Email(*)
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  13. Second Email
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  14. School Counselor Email(*)
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  1. Student: In 1500 characters or less tell us your post graduation career plans:
    You have characters left.
    If you cut and paste your text and it is longer than 1500 characters, it will automatically be truncated
  2. (*)
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  1. Please Copy and Paste your sponsors paragraph(s)

    Limit 750 characters or less:
    You have characters left.
    If you cut and paste your text and it is longer than 750 characters, it will automatically be truncated.
  2. (*)
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  1. Please give us some information about the Sponsor.
  2. Name of Sponsoring PIA Member
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  3. Submitted by
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  4. Agency/Company
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  5. Sponsor Address
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  6. Sponsor City
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  7. Sponsor State
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  8. Sponsor Zip
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  9. Sponsor Phone
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  10. Relationship to student
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  11. Sponsor Email(*)
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  13. A check will be presented to the scholarship winners at the Opening Party at the PIA Convention in August; you must be present to receive your scholarship. Scholarships awarded at the discretion of PIA of Wisconsin.

Featured Benefit: PIAW INS Programs

PIAW INS5

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Professional Insurance Agents of Wisconsin
6401 Odana Road | Madison, WI 53719
Phone: (608) 274-8188 | Toll Free (800) 261-7429
Fax: (608) 274-8195 | Toll Free (866) 203-7461

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