Survivor

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A deceased person’s spouse and children under 18.

Social Security Insurance provides benefits for the survivors of workers who are covered by social security.

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First Name

Last Name

Phone Number

Are you a student or a professional?

Residing State *

What state is your campus located in? *

College (legacy taxonomy)

Expected or Past Undergrad Graduation Date *

When do you plan to start studying? *

Current/Future Employer

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