PLEASE ALLOW 2-3 WEEKS TO COMPLETE THE REFERRAL PROCESS

Wyandotte Public Schools
MADISON
New Student Referral Packet
Date of referral____________________  Desired start date____________________

Student’s name___________________________________ D.O.B._____________

Referring District _______________________School________________________

Student’s certification ( SCI, SXI) ___________________________

Parent/Guardian__________________________________ Phone______________

Address___________________________________ City_____________________

Zip________________ Native language of student__________________________

Name of person initiating the referral_____________________________________

Phone__________________________ E-mail______________________________