Scholarship

Applicant (Student) Email Address *

Name of Member (Parent/Guardian): *

Member (Parent/Guardian) Email Address *

Member (Parent/Guardian) Mailing Address *

Date Transcripts Requested *

Name of Applicant (Student Name) *

Spring Schedule Sent To Local 391 *

YES

NO

Dependent of Member: *

YES

NO

Transcripts requested from Institution: *

YES

NO

Applicant (Student) Phone *

Applicant (Student) Complete Mailing Address *

Member Phone (Parent/Guardian): *

Name of Accredited Institution: *

Schedule Sent VIA: *

Email (local391scholarship@gmail.com)

USPS (c/o Local 391 Scholarship Committee 55 Main St. Suite 5500 Enfield CT 06082)

AFSCME Local 391