Cic 2134 Form PDF Details

Understanding the Cic 2134 form is essential for students and their families seeking insurance discounts based on academic performance. Offered by Commerce Insurance, located at 211 Main Street in Webster, Massachusetts, this form plays a crucial role in the process. It serves not only as a vehicle for securing a Good Student Discount but also as a testament to a student's academic achievements. The form requires specific information, including details about the student, such as name and school class ranging from freshman to senior, as well as comprehensive school information. Furthermore, it demands academic certification by a school official, verifying that the student meets one of several criteria indicating high scholastic performance, such as being in the upper 20% of their class, maintaining a "B" average or its equivalent, or a numerical grade point average of 3.0 or more. Additionally, it has provisions for home-schooled students, allowing them to qualify for the discount by presenting standardized test scores or third-party certifications proving their academic merit. The Cic 2134 form thus encapsulates an important opportunity for diligent students to gain recognition and financial benefits, marking a significant intersection between academic performance and insurance policy advantages.

QuestionAnswer
Form NameCic 2134 Form
Form Length1 pages
Fillable?No
Fillable fields0
Avg. time to fill out15 sec
Other namesallstate good student form, state farm insurance good student discount, state farm good student discount unofficial transcript, state farm student discount

Form Preview Example

COMMERCE INSURANCE, 211 MAIN STREET, WEBSTER, MASSACHUSETTS 01570 (508) 943·9000

GOOD STUDENT DISCOUNT FORM

Named Insured

 

Producer Name:

Mailing Address

 

Producer Code:

City/State

Zip Code

Policy Effective Date:

STUDENT INFORMATION

StudentName: --------------------------------------

School Class: Freshman ___ Sophomore ____ Junior __ Senior __

SCHOOL INFORMATION

School Name and Address:

ACADEMIC CERTIFICATION (To be Completed by School Official)

For the academic period immediately preceding this certification, the student noted above has met one of the following requirements:

__ Is in the upper 20% of his or her class scholastically; OR

__ Maintains a "B" average or higher, or its equivalent, or if the letter grading system cannot be average then no grade is below a "B"; OR

__ Maintains a numerical grade point average or "3.0", in a system assigning numerical grade points of 4.0, 3.0, 2.0, and 1.0; OR

__ Was included on the "Dean's List", "Honor Roll", or comparable list indicating scholastic achievement.

Date

Name and Title of School Official

Signature of School Official

ACADEMIC CERTIFICATION - HOME SCHOOLED STUDENTS

For Home Schooled students, two certification options are available:

__ Attach a standardized form certified by a 3rd party organization showing evidence that one of the above listed qualifications has been satisfied; OR

___ Attach evidence of the student scoring in the upper 20% on an annual national standardized exam.

CIC-2134 {4/09)

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filling out state farm student discount part 1

In the Maintains a B average or higher, no grade is below a B or, Maintains a numerical grade point, and or, Was included on the Deans List, Date, Name and Title of School Official, Signature of School Official, Academic Certification Home, For Home Schooled students two, Attach a standardized form, listed qualifications has been, and Attach evidence of the student box, type in your information.

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