Welcome to The Compass Fund

Students Name(s):
Date of Birth:	/ /
Present grade:
Elementary school presently attending:
This is a:	Public School Private School
Parent/Guardian name:
Parent/Guardian address:
City:
State:
Zip:
Home phone:
Work phone:
Total number of persons living in the household:
Annual Household income:
Email:
Relationship to student:	Mother Father Guardian

Please print this application and mail to:
Michele Hull
The Compass Scholarship Fund
95 Glastonbury Boulevard, Suite 214
Glastonbury, CT 06033
860-659-0050 x101