¨ Fill out Part I on Page 1.
¨ Must be signed by parent/guardian.
¨ Physical Fitness Certification on page 3 must be signed by Family Physician.
¨ Return form to the Guidance Office by one of the following methods:
- Email: firstname.lastname@example.org
- Fax: 631-474-2734
- Mail: MPHS Guidance Office, 15 Memorial Drive, Miller Place, NY 11764
Once received, the employment certificate will be mailed home.
Please print out pages below: