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Workers' Compensation (States other than Michigan)

Evidence of Workers' Compensation insurance issued for MSU employees working outside of Michigan.


* indicates required field

MSU Faculty, Staff or Student

Certificate Holder

Activity / Contract Information


Send a contract or documentation if available (PDF, Word and Excel files preferred).
Files may be submitted electronically from the MSU FileDepot website (instructions provided after completing this form).

Do you have documents to send in?

The certificate of insurance will be emailed to the MSU NetID provided.
Please allow 3-5 business days for receipt of the certificate.

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