Service Request

Intake Form Complete


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Current Grade Level

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Potential Schools

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Eligibility

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INFORMATION RELEASE AUTHORIZATION

I (we) declare that the information reported in this form is true, correct and complete to the best of my (our) knowledge. I (we) hereby authorize CONNTAC to obtain any information required from the Registrar, Financial Aid Office(s), Adult Education, Department of Labor, Department of Corrections and/or credit reporting agency(s) [for the purpose of obtaining defaulted student loan(s)Status] of the schools(s) I have applied to, I am attending or, I have attended]

PLEASE BE SURE TO SIGN THIS AUTHORIZATION

All information is confidential per FERPA. CONNTAC is a TRIO program, federally funded by the United States Department of Education

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Contact Us

  • 35 Pleasant Street Unit 1-C, Meriden, CT 06450
  • 203-634-7669 x 10