AFSCME Local 391

Name of Member: *

Schedule Sent via *

Email (To local391afscme@gmail.com)

USPS (To Local 391 55 Main st Suite 5500 Enfield CT 06082)

Applicant Mailing Address *

Transcript Request Date *

Name of Applicant: *

Transcripts requested from Institution: *

Yes

Member Address *

Member Mailing Address *

LOCAL 391-SCHOLARSHIP

Name of Accredited Institution *

Sent Copies of Spring Semester Schedule to Local 391 *

Yes

Relationship to Member *

Mother

Father

Member Phone *

Member (Parent/guardian) Facility *