Application for Grade Six
Application should be mailed to:
Marcus Whitman District Office
4100 Baldwin Rd.
Rushville, NY 14544
Application is due by Tuesday, June 2, 2020
Student’s name: __________________________________________________
Telephone number: ( )______________________________________ Name of Parent/Guardian:_______________________________________________
Email address: _______________________________________________________ Current grade level: ___________ Current school and teacher: ____________
Date of birth: _____________ Gender: _____________
Does the student live in the Marcus Whitman Central School District? Yes / No
We recognize that participation in the Marcus Whitman ECO Program requires a special commitment by the student and parent requiring student and parental participation in a school day that usually ends at 3 p.m., occasional school activities/meetings beyond the regular day, student participation in strenuous outdoor activities throughout the year, proper clothing for various activities, and daily academic rigor and preparation. We agree to meet this responsibility.
student’s signature parent/guardian’s signature