This form is not being accepted at this time. You may utilize it for budgeting purposes, but it will not be accepted for the 2020-21 period until August of 2020. 



The premium charged to the chapter is calculated taking the base rate per man multiplied by the number of active members at the end of the spring semester (April 30th). This number of active members is calculated using the following formula:

(Total Membership on Vault as of the deadline set by the International Headquarters) – 5% rounded to the nearest dollar.

Each chapter will be eligible for certain discounts and surcharges based on performance and behavior. Each chapter will start off at a base rate of $295 per man and will have surcharges and discounts applied towards that amount.

Delta Chi recognizes that some groups take great measures to ensure the safety of members and guests, while likewise, some have increased the overall risk to Delta Chi.

Step 1: Fill out the basic information in the first five fields.
Step 2: Fill out the below components to the best of your abilities.
Step 3: Click "Calculate" under the heading "Total discounts/surcharges to be applied per man."
For explanation on a component, hold your cursor over the question mark (?) next to the relevant component for a brief description. 

Factor in discounts/surcharges:

Fill out the below items as accutately as possible to determine what discounts/surcharges could be applied to your premium.
Total discount/surcharge to be applied per man:
Please note: All information will be verified by a Headquarters Staff member. Information that cannot be verified or that is found to be inaccurate will not count towards a chapters or colony's premium.


Based on the information submitted above, your insurance premium for 2019-20 could be represented by the number below. Submissions will be verified by a staff member for accuracy. The Base Rate for 2019 as set by the Board of Regents is $295 per man; discounts and surcharges submitted in this form will be factored in to this rate.
Rate-Per-Man Risk Management Bill:
Your total bill will be calculated by using the number above (once verified) multiplied by the number of active members in your chapter or colony. Active membership is determined based on the formula: (Spring Active Members + Spring Associate Members + Holdover Associate Members – Graduates) –5%. 
*Chapters that have property and wish to receive credit for either making that property alcohol-free or only having social events at Third Party Vendors must fill out the appropriate forms. These can be found here. These forms as well as any additional documentation must be returned to Headquarters no later than September 15th for chapters on semesters and October 1st for chapters on quarters. Chapters that are approved for either discount that are later to be found violating this agreement will be rebilled at a rate of double the amount credited.