The Brass Ring Project Subsidy Application
In order to be considered for a subsidy for Career and College Coaching services through The Brass Ring Project, please fill out this form in it's entirety.

Applications received by the 1st of the month can expect to receive a reply by the 15th of the month.

We will confidentially review your financial situation, and based on the National Household Income Percentile, offer the services at a price your family can afford. For example, if your family is at the 30% of the National Household Income Percentile, your family will pay 30% of the fees, and The Brass Ring Project will pay the remaining 70%.

Services will be provided free to families with an annual income at or below the WIC Eligibility level ($45,991)

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Student Name *
High School Graduation Year  *
Parent/Guardian Name(s) *
Address *
Email Address *
Phone Number *
Adjusted Annual Gross Income 

** In follow-up to this form, please forward by either email or mail your  most recent IRS form 1040 or if your income was less than $12,950, provide a copy of your W2 or 1099   (to protect your privacy, please redact your Social Security Number and any other sensitive information you do not wish to share)

Email:  tleahy@thebrassringproject.org

Mail:  The Brass Ring Project
           Tom Leahy
           14321 Winter Breeze Dr. Ste 115
           Midlothian, Virginia   23113

 *
In order to be considered for a subsidy from the Brass Ring Project for Career and College Coaching, we want to hear from the student, in their own words, what they hope to get out of this process.  
Please feel free to be creative -- tell us your hopes and dreams for the future, share what you are currently involved in, and/or anything else you want us to know about you.  
(500 words)
 *
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