Medicaid Consent Notice

If your child receives Medicaid benefits, please follow these instructions: 

1. Click the link below to access the form.

2. Print the form and complete all required sections.

3. Sign the completed form. 

4. Return the signed (ink signature) form to Tricia Cormier in Student Services:

   1. 1. • Email: StudentServices@wellesleyps.org

or

4. 1. 1. • Mail:  Wellesley Public Schools 

              Attn: Student Services

              40 Kingsbury Street

              Wellesley, Ma 02481