Note: If you need transportation assistance you must complete this form. If you have questions
regarding transportation assistance please contact Jean Lawrence at firstname.lastname@example.org or
860/685-2968 by Friday, April 4, 2014.
WE ALSO REQUIRE A SIGNED MEDICAL RELEASE/PERMISSION FORM. Please fax the
completed form to the Office of Admission at 860-685-3001, ATTN: Jean Lawrence by Monday,
April 14, 2014. You may also email the form to email@example.com.