Certificate of Insurance Request

Please complete the form below 

  • The purpose of a Certificate of Insurance is to provide proof of coverage under California State University, Stanislaus’ insurance for off-campus University-related events.
  • This form serves as a formal request for a Certificate of Insurance. It is important that all fields are completed to ensure an accurate Certificate. Please contact the Risk Manager with any questions.

* Required Fields

(Include area code)
(Include area code)
Certificate Holder Information
(Include area code)
Files must be less than 2 MB.
Allowed file types: gif jpg png pdf doc docx.
Allow ten business days for processing. The certificate will be e-mailed in pdf format to both the requesting University department contact person and the outside entity contact person.