Admissions Procedure and Application Checklist
Please submit the following documents so your child can be considered for admission to the Cooke Center
School. All reports and evaluations must be current, i.e. they must be less than 24 months old.
Required:
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Application for Admission
Individualized Education Program (IEP)
Psycho Educational Testing
School Report Card
When Applicable:
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Speech and Language Evaluation
Occupational Therapy Evaluation
Physical Therapy Evaluation
Educational Evaluation
Social History
Medical Reports
Please note: After completing this application, the above items must be submitted to the address below via
post. You may also drop them off by hand during regular school hours. Incomplete applications will not be
reviewed.
Cooke Center School
Office of Admissions
219 Stanton Street
New York, NY 10002
Upon receipt of your application, our admissions team will begin a review process. Within two weeks time,
we will contact you and provide an update on the status of your application. In some cases, we may invite
you and your child to come in for an interview appointment. We may also wish to contact your child’s
teacher and visit their current classroom.
Following these initial steps, if we continue to believe that the Cooke Center School might be an appropriate
setting for your child’s needs, we will invite your child to visit one of our classrooms and work amongst our
staff and students. In most cases, this represents the final step in our decision making process.
For questions or concerns, please contact our Admissions Associate at 212-995-1987.
COOKE CENTER SCHOOL
APPLICATION FOR ADMISSION
COOKE CENTER SCHOOL
2016 APPLICATION FOR ADMISSION
SECTION 1: STUDENT INFORMATION
Child’s Name:
Current School:
Date of Birth:
School Address:
Sex (circle one):
MALE /
FEMALE
Current Grade:
School Telephone:
Current Classroom Staffing Ratio:
Teacher’s Name:
IEP Classification:
Teacher’s Email:
SECTION 2: FAMILY INFORMATION
Parent/Guardian
Parent/Guardian
Name
Name
Relationship to Applicant
Relationship to Applicant
Address
Address
City, State, Zip
City, State, Zip
Home Phone
Home Phone
Cell Phone
Cell Phone
Email Address
Email Address
Job Title
Job Title
Employer
Employer
Work Phone
Work Phone
Single Parent Household
Parental Status (check all that apply)
Both Parents in one Household
Divorced
Deceased Partner
Other:
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Separated
Remarried
COOKE CENTER SCHOOL
APPLICATION FOR ADMISSION
Please list the names of siblings or other children who live in the applicant’s household:
Name
Date of Birth
School
Please list the names of other adults (including caregivers) who live in the household:
Name
Relationship
SECTION 3: EDUCATIONAL HISTORY
Please list the names of schools your child has attended, from preschool to present. Please place an (X)
next to any schools in which your child received special education services.
X
Name
Years Attended
to
to
to
to
to
to
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Grade(s)
COOKE CENTER SCHOOL
APPLICATION FOR ADMISSION
Why are you seeking new school placement?
When was the first time that your child received an IEP? Has your child ever received special education
services in a public school, or funded by the NYC Department of Education?
SECTION 4: DESCRIPTION OF SPECIAL NEEDS
Describe your child’s personality. What kind of people, places, and/or things does he/she like? What does
he/she avoid?
What do you believe are your child’s greatest strengths?
What are your child’s current difficulties?
How long have these difficulties been a concern? How were they brought to your attention?
How does your child react when he/she becomes upset or frustrated?
What have you found to be the most effective ways of responding to your child when he/she becomes upset
or frustrated? How long does it typically take for your child to settle?
Are you working with your child on any non school-related goals that you would like us to support?
Is your child physically able to climb stairs and participate in active games? If not, please explain.
What kind, if any, medication do they take? How long have they used this medication?
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COOKE CENTER SCHOOL
APPLICATION FOR ADMISSION
Are there any issues related to bowel or bladder control? If so, please explain.
Please add any additional information that you would like us to know about your child or your family.
SECTION 5: GENERAL INFORMATION
How did you hear about the Cooke Center School? Please be as specific as possible.
Do you have any friends or relatives who have attended the Cooke Center School? If yes, who?
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COOKE CENTER SCHOOL
APPLICATION FOR ADMISSION
SECTION 6: SOCIAL AND BEHAVIORAL CHECKLIST
Place a check next to any behavior or problem that your child currently exhibits:
Has difficulty with speech
Sucks thumb
Has difficulty with hearing
Has frequent tantrums
Has difficulty with language
Has frequent nightmares
Has difficulty with vision
Has trouble sleeping
Prefers to be alone
Rocks back and forth
Does not get along with brothers and sisters
Bangs head
Is aggressive
Eats poorly
Is shy or timid
Has poor bowel control (soils self)
Is more interested in things (objects) than people
Is much too active
Engages in behavior that could be dangerous to self or
others
Has special fears, habits or mannerisms
Is clumsy
Wets bed
Has blank spells
Bites nails
Is impulsive
Gives up easily
Shows daredevil behavior
Other
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COOKE CENTER SCHOOL
APPLICATION FOR ADMISSION
SECTION 7: RELEASE FORM
Child’s Name:
I give the Cooke Center School permission to contact the following people for comments and/or release of
transcript, teacher reports, and any standardized testing:
Name
Phone
Current School:
SEIT:
Psychologist:
Neurologist:
Speech Therapist:
Occupational Therapist:
Physical Therapist:
Educational Attorney:
Advocate:
Other:
I understand that the information requested is for professional use and will remain confidential.
Parent’s Signature:
Date:
The Cooke Center for Learning & Development admits students of any race, color, national and ethnic origin
to all the rights, privileges, programs, and activities generally accorded or made available to the students at
the school. It does not discriminate on the basis of race, color, national and ethnic origin in the
administration of any policies or programs, including its educational policies, admissions policies and athletic
and other school administered programs.
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