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1. PLEASE FULLY COMPLETE THIS FORM 2. ATTACH ITEMIZED BILLS AND PRIMARY CARRIER EXPLANATION OF BENEFITS 3. MAIL TO HER Plaza II 4100 Medical Parkway Carrollton, Texas 75007 Phone: (972) 5125600 Fax:
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Part I National Intercollegiate is a section of a form or document related to intercollegiate activities at a national level.
Any institution or organization participating in national intercollegiate activities is required to file Part I National Intercollegiate.
Part I National Intercollegiate can be filled out by providing accurate and detailed information about the institution's involvement in national intercollegiate activities.
The purpose of Part I National Intercollegiate is to gather information about institutions participating in national intercollegiate activities for regulatory or compliance purposes.
Part I National Intercollegiate may require reporting of details such as the types of activities involved, funding sources, and any compliance measures taken by the institution.
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