Quitman County Summer School Application
Schools Participating with Virtual Learning: Madison Shannon Palmer High School, Quitman County Middle School, and Quitman County Elementary School. Please submit a new form for each student enrolling.
Email address *
Due to COVID-19, summer learning will be online and will include instructional packets and virtual presentations by teachers.
Do you have a computer? *
Do you have an iPad? *
Do you have internet access? *
Student's Name *
Student's Date of Birth *
MM
/
DD
/
YYYY
Student's Address *
Grade/School 2019-20 School Year *
Parent's Name *
Parent's Primary Address
Parent's Primary Phone Number *
Parent's alternate phone number
Parent's alternate email address
Alternative contact name and phone number *
A copy of your responses will be emailed to the address you provided.
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