Application for Grade Six
Application should be submitted to: Dr. Susan Wissick, Gorham Intermediate Principal
Or mail to: Dr. Clayton Cole, Principal
Marcus Whitman Middle School 4100 Baldwin Rd.
Rushville, NY 14544
Application is due by Tuesday, June 4, 2019
Name of Parent/Guardian:_______________________________________________ LLLLLLLL
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