Online Interactive Application for Admission

This is a long form that might require a lot of time to complete. It is possible for you to save the form as you keep working on it and come back to it later when you are ready with the information. You find the "Save for Later" button at the end of this form.

All information in the form must be completed in order to submit. If you are not sure of the response, please enter NA/None

Date of Applicationrequired (mm/dd/yyyy)

Program Applying forrequired

Graderequired

Attention:

If you are looking for immediate placement, please call admissions at 212-223-5055 and DO NOT continue filling out this form.

Desired Date of Admissionsrequired

Upload Photo of Applicant

Max file size: 10 MB

Applicant Basic Information

Firstrequired

Middle

Lastrequired

Nickname/Common namerequired

NYC#required

Birthdayrequired

Addressrequired

Cityrequired

Staterequired

Ziprequired

Gender*

Male Female

Current Diagnosis/Classificationrequired

Are Parentsrequired

Child's Living Arrangements

Living With*

Both parents Mother Father Other

Please Explainrequired

Who is legal guardian?required

Contact Information

Primary Contact*

Father Mother Other

Titlerequired

Firstrequired

Middlerequired

Lastrequired

Home Addressrequired

Cityrequired

Staterequired

Zip

Home Phonerequired

Cell Phonerequired

Email Addressrequired

Employer Namerequired

Employer Addressrequired

Cityrequired

Staterequired

Ziprequired

Type of Businessrequired

Title/Position at workrequired

Degree(s)required

Secondary Contact

Father Mother Other

Title

First

Middle

Last

Home Address

Same as Primary Contact Different from Primary Contact

Home Address

City

State

Zip

Home Phone

Cell Phone

Email Address

Employer Name

Employer Address

City

State

Zip

Type of Business

Title/Position at work

Degree(s)

Applicant's Current Schoolrequired

Present Graderequired

School Head/Principal/Counselorrequired

Address of the Schoolrequired

Cityrequired

Staterequired

Ziprequired

Districtrequired

Best School Contact

Namerequired

Title/Positionrequired

Phonerequired

Emailrequired

Please list previous schools starting with pre-school

Previous school, address, grade and dates attendedrequired

Has applicant ever repeated a grade?*

Yes No

Which Grade?required

Has applicant ever been dismissed or suspended from school? *

Yes No

Reasonrequired

Dates of suspensionrequired (mm/dd/yyyy)

Please describe your child’s:

Chief Strengthsrequired

Areas of greatest needsrequired

Study and work habitsrequired

Special interests, hobbies, and abilities (e.g.: sports, music, dancing, and art)required

Has your child had any significant, physical, emotional, or health problems? *

Yes No

Please Explainrequired

In what ways would you like to see your child grow in The Child School/Legacy High School?required

What are your expectations upon your son/daughter’s high school graduation? required

Parent Questionnaire:

Does your child have household chores to do?*

Yes No

What are they?required

What are the consequences for your child if they do not follow your rules? required

Does your child have a curfew?*

Not at this time Yes No

Time of curfewrequired

How does your child typically deal with stress and/or cope with difficult situations? required

In what academic areas do you believe your child requires special help? required

Is your child a leader or a follower? Please describerequired

Has your child experimented with drugs? (In order to safeguard your child, it is important for us to know)required

What do you see as your child’s magic? What would you characterize as special about them?required

How do you think your child’s school can help him succeed? required

Developmental History
Family Overview:

Sibling 1's name, Age, School, Grade and Sibling Interaction

2 Siblings' Names, Ages, Schools, Grades and Siblings Interactions

3 Siblings' Names, Ages, Schools, Grades and Siblings Interactions

More than 3 Siblings' Names, Ages, Schools, Grades and Siblings Interactions

Are there any important events (e.g.: moving, divorce, accidents, illnesses, deaths) in your family that have affected your child? How do you feel your child has been affected?required

What has your child had the most difficulty adjusting to in his/her life?required

When did you suspect your child had difficulties and what did you think the difficulty was?required

Have other family members had learning problems? Please describe how they are related to your child?required

Pregnancy, Birth and Early History

Was your child adopted?*

Yes No

At What Age?required

Mother’s age at the time of pregnancyrequired

Were there complications of pregnancy and/or delivery (e.g.: toxemia, breech birth, forceps delivery, Cesarean section, other)?required

What was your child’s condition at birth? (e.g.: jaundice, Apgar score, birth weight)?required

Was their weight gain satisfactory in the first few months? required

What was your child like as a baby? (Describe activity level, sleep pattern, hearing response to nurturing, response to a schedule)required

Describe your child as a toddler (Were they quiet, even tempered, clingy, independent, impulsive, active, negative)required

Medical History

What operations, accidents or serious illnesses has your child had and at what ages? Please describe circumstances (e.g.: hospitalization, child’s reaction and adjustment)required

Does your child have a history of ear and/or upper respiratory infections? If so, please describerequired

Has your child ever had high fevers and/or convulsions? If yes, please describe:required

Does your child have any chronic conditions (e.g.: allergies, asthma, epilepsy) that the school should know about? required

Does your child take any prescribed meditations or need any special medical attention? If yes, please explainrequired

Physical Development:

At what age did your child crawl?required

At what age did your child sit?required

At what age did your child stand?required

At what age did your child walk?required

At what age did your child tie shoes?required

At what age was your child toilet trained?required

What are your child’s present sleeping habits? Are there any difficulties?required

What are your child’s present eating habits? Are there any difficulties?required

Language Development

When did your child say the first word?required

When did your child begin combining two and three words together?required

When did your child begin to understand spoken word?required

Does your child have difficulty following 2-3 step verbal directions?required

Does your child have difficulty expressing their ideas?required

Can they retell a story in a logical order?required

Other than English, are there any other languages spoken at home?*

Yes No

If so, which language(s)? required

By whom?required

Does your child speak another language?*

Yes No

What language(s)?required

Describe your child’s reaction to their first school/day experience. (E.g. ability to separate, follow routines, interact with teachers and peers)required

Describe the kinds of problems your child has in school. Academic/Social/Behavioral. When did you first learn of them? required

Describe your child’s level of maturity.required

Does your child have any school friends?*

Yes No

What grade(s) are they in?required

Does your child have any friends outside of school?*

Yes No

What age are they?required

Describe your child’s typical interaction with friends or peers.required

Describe your child’s typical response to adults?required

What is your child like at home? (Include activity level, activity preferences, ability to play alone, relations with siblings, responsiveness to your directions.)required

How does your child feel about their difficulties?required

What are your feelings about your child’s difficulties?required

Student Questionnaire and Essay

(For students in grades 7-12)

Applicant’s Name

Date (mm/dd/yyyy)

Questionnaire

The Child School/Legacy High School represents a chance to achieve things you may not have thought were possible in your life. Please answer the following questions so we can determine the kind of support you will require to reach your goals.

In what academic areas do you need help?

What behavior gets in the way of your learning?

What has prevented you from being successful in other programs?

Do you have chores at home? Please explain.

What time is your curfew?

What are the consequences for you when you do not follow the rules at home?

Would you describe yourself as a leader or a follower?

Have you experimented with drugs? Are you a smoker? (Please be honest. Whatever you tell us will be kept confidential.)

Essay

The essay is to be completed by the candidate applying for admissions to Grades 7-12. Families are requested not to assist in the writing or editing of this essay. This essay should reflect the applicant’s thoughts and feelings in their own words.

Please write an essay telling us about yourself. What do you think about school, home, and your future? and upload it as directed.

Upload the Essay

Max file size: 10 MB

How did you find out about The Child School/Legacy High School?

I found out fromrequired

Name of Directorrequired

Name of Educational Consultantrequired

Name Otherrequired

Please list any friend/relatives who have attended The Child School/Legacy High School.required

Have you applied to The Child School/Legacy High School in the past?*

Yes No

Materials Submission Checklist:

To be considered for admission at The Child School/Legacy High School, please complete and turn in all paperwork at the same time:

1. Application:

A) PDF Application that you have filled out

Max file size: 10 MB

B) Online Interactive Application

2. Most Current IEP (within 1 year)required

Max file size: 10 MB

3. Most Current Psycho-Educational/Or Neuropsychological Evaluation (within 3 years)required

Max file size: 10 MB

4. Current Related Service Provider Reports (if applicable)

This is optional, but will help us in working with your child

Max file size: 10 MB

5. School Transcript (grades 7-12)

Max file size: 10 MB

6. 2 years of Report Cards (PreK-8)

Max file size: 10 MB

In the paper version of The Child School/Legacy High School application, distributed on tours, the Teacher/Therapist Questionnaire is an optional form which can be substituted for the Current Service Provider Reports listed in the checklist above. Either the reports or the completed form is acceptable.

Please Note: Please ensure that you keep copies of all documentation as forms will not be returned after their submission.