Is your org a 501(c)(3)? Yes No - Stop here! Must be 501c3
Do you have 10+ employees? Yes No - Stop here! You must have 10+ FTEs
First Name
Last Name
Title
Email
Phone
Organization
Zip
# of Full Time Employees
# of Part Time Employees
Gross Annual Wages
Annual SUI/SUTA Wages
Do you pay state UI taxes? Pay Taxes Reimbursing for Claims
If you pay UI taxes, what is your current tax rate (%)?
Total $ Claims Paid 2019
Total $ Claims Paid 2020
Total $ Claims Paid 2021
How did you hear about UST?
Priority Code (if any)
Comments