Application - Childrens Advocacy Center Insurance Program

To begin the application process, download the attached PDF form. Please complete the form in its entirety. This form is designed to be completed electronically with check boxes and text blocks using a PDF reader like Adobe Acrobat. After the form has been completed, you can email the electronic form to dharbarger@fphins.com or fax it to (256) 428-1114.

If you have questions regarding the application process or simply would like to discuss CACip before submitting an applications, please contact David Harbarger at 256-428-1014 or Cindy White at 256-428-1013.

CACip Application (PDF  760KB)