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CMS Admissions Application

Connelly Middle School (CMS) is a full scholarship school for those who need financial assistance. A majority of our students come from families with low incomes (qualify for free or reduced lunch). In the 2024-2025 school year, all five boroughs of New York City are represented at CCC: 75% of our students are from Manhattan, 12% are from Brooklyn, 5% are from the Bronx, 4% are from Queens, 2% are from Staten Island, and 2% live outside NYC. 83% of our students identify as Hispanic, 9% as multi-racial, 5% as African American, 2% as White, and 1% identify as other.

Read all instructions before submitting your application. Incomplete applications will not be accepted. Required fields are marked with an asterisk (*). Please note that you cannot save the application online.

If you prefer, you may pick up a paper application at the front office (220 East 4th Street, New York, NY 10009).

In addition to the application, you must supply the following documents by emailing them to [email protected] or bringing them to the front office:

Copy of student’s birth certificate
Most recent completed tax return (form 1040) and last two pay stubs
Proof of Social Security benefits or Public Assistance (if applicable)
Her most recent report card/student academic records and state test scores (if available)

If you have questions, please contact Brittany Sachs at [email protected].

Policy of Non-Discrimination: Cornelia Connelly Center - Connelly Middle School admits students of any race, color, creed, or national origin to all rights, privileges, programs, and activities generally accorded or made available at the school. Cornelia Connelly Center - Connelly Middle School does not discriminate on the basis of race, color, creed, or national origin in the administration of its educational policies and scholarship, athletic, and other administered programs.

Student Information

First Name*

Answer required for "First Name"

Middle Name

Answer required for "Middle Name"

Last Name*

Answer required for "Last Name"

Date of Birth*

Answer required for "Date of Birth"

Age*

Answer required for "Age"

Address*

Answer required for "Address"

City*

Answer required for "City"

State*

Answer required for "State"

Zip Code*

Answer required for "Zip Code"

Phone Number*

Number Required

Present School*

Answer required for "Present School"

Present Grade*

Answer required for "Present Grade"

NYC School I.D. Number

Answer required for "NYC School I.D. Number"

School History: List all the schools your student has attended. Begin with the first school they attended.

For all schools attended, provide School Name, Location, Grade(s) Attended.*

Answer required for "For all schools attended, provide School Name, Location, Grade(s) Attended."

How did you hear about our school? (Please check one)

Answer required for "How did you hear about our school? (Please check one)"

Current student and/or her family member

Graduate and/or her family member

Walked past our building

Heard CCC staff member speak

Saw a flier

Other:

If you learned about CCC from a student or graduate or her family, please provide their name.

Answer required for "If you learned about CCC from a student or graduate or her family, please provide their name."

If other, please describe.

Answer required for "If other, please describe."

Family Information (Please supply contact information for both parents and/or legal guardians.)

We strive to communicate with families in their preferred language. What is the primary language spoken in your home?

Answer required for "We strive to communicate with families in their preferred language. What is the primary language spoken in your home?"

Mother

Full Name

Answer required for "Full Name"

Address

Answer required for "Address"

Home Phone

Number Required

Cell Phone

Number Required

Employer

Answer required for "Employer"

Occupation

Answer required for "Occupation"

Work Phone

Number Required

Answer required for "Email"

Father

Full Name

Answer required for "Full Name"

Address

Answer required for "Address"

Home Phone

Number Required

Cell Phone

Number Required

Employer

Answer required for "Employer"

Occupation

Answer required for "Occupation"

Work Phone

Number Required

Answer required for "Email"

Guardian (if applicable)

Full Name

Answer required for "Full Name"

Address

Answer required for "Address"

Home Phone

Number Required

Cell Phone

Number Required

Employer

Answer required for "Employer"

Occupation

Answer required for "Occupation"

Work Phone

Number Required

Answer required for "Email"

Please check all that apply

Answer required for "Please check all that apply"

Parents live together

Parents are divorced or separated

Mother deceased

Mother remarried

Father deceased

Father remarried

With whom does the student live?*

Answer required for "With whom does the student live?"

Religious Affiliation (optional)

Religion

Answer required for "Religion"

Parish/Church

Answer required for "Parish/Church"

Ethnic Background (optional)

Answer required for "Ethnic Background (optional)"

Hispanic

Asian

Caucasian

Black

Multiple ethnicities

Other

If other, please elaborate.

Answer required for "If other, please elaborate."

Mother's Birth Place

Answer required for "Mother's Birth Place"

Father's Birth Place

Answer required for "Father's Birth Place"

Household Information

Please provide the following information for all children ages 0-17 living with the student at the current address: Name, Age, Relationship to Student, School Name*

Answer required for "Please provide the following information for all children ages 0-17 living with the student at the current address: Name, Age, Relationship to Student, School Name"

Please provide the following information for all adults (over 18) living with the student at the current address: Name, Age, Relationship to Student, Occupation*

Answer required for "Please provide the following information for all adults (over 18) living with the student at the current address: Name, Age, Relationship to Student, Occupation"

Income Information

CCC is committed to serving students who are most in need of our program. For this reason, we ask parents/guardians to disclose income information as part of the application process. Currently, the majority of our student body qualifies for the federal Free/Reduced lunch program.

Monthly Income

Mother

Gross Monthly Income (before taxes)

Answer required for "Gross Monthly Income (before taxes)"

Monthly Child Support or Alimony Received

Answer required for "Monthly Child Support or Alimony Received"

Public Assistance, Social Security Benefits, 2nd Job Income, or any other income

Answer required for "Public Assistance, Social Security Benefits, 2nd Job Income, or any other income"

Father

Gross Monthly Income

Answer required for "Gross Monthly Income"

Month Child Support or Alimony Received

Answer required for "Month Child Support or Alimony Received"

Public Assistance, Social Security Benefits, 2nd Job Income, or any other income

Answer required for "Public Assistance, Social Security Benefits, 2nd Job Income, or any other income"

Other Adult Supporting Child

Gross Monthly Income

Answer required for "Gross Monthly Income"

Monthly Child Support or Alimony Received

Answer required for "Monthly Child Support or Alimony Received"

Public Assistance, Social Security Benefits, 2nd Job Income, or any other income

Answer required for "Public Assistance, Social Security Benefits, 2nd Job Income, or any other income"

Please provide the names and Social Security numbers of all parents/guardians.

Answer required for "Please provide the names and Social Security numbers of all parents/guardians."

Student Description

Why do you want your student to attend CCC?*

Answer required for "Why do you want your student to attend CCC?"

Are their any areas (academic, social, emotional, etc.) in which your student needs improvement? Please name them.*

Answer required for "Are their any areas (academic, social, emotional, etc.) in which your student needs improvement? Please name them."

Please list any after school programs and/or weekend programs that your student participates in.*

Answer required for "Please list any after school programs and/or weekend programs that your student participates in."

How does your student usually spend her summer?*

Answer required for "How does your student usually spend her summer?"

Teacher Contact Information.

Please provide contact information for your student's two most recent teachers. If she is applying for 4th grade, her 2nd and 3rd grade teachers; if she is applying for 5th grade, her 3rd and 4th grade teachers.

For each teacher, provide: Teacher Name, School, Phone Number, Email Address*

Answer required for "For each teacher, provide: Teacher Name, School, Phone Number, Email Address"

Family/Guardian Signature

Please check below indicating that you understand and agree to the following:

I understand that my family is responsible for nominal fees each year (4th - 6th grade = $100, 7th grade = $200, 8th grade = $300)*

Answer required for "I understand that my family is responsible for nominal fees each year (4th - 6th grade = $100, 7th grade = $200, 8th grade = $300)"

I understand

I understand that my family is responsible for purchasing my student's uniform (which she is required to wear every day).*

Answer required for "I understand that my family is responsible for purchasing my student's uniform (which she is required to wear every day)."

I understand

I understand that CMS has a school counselor that each student visits on a periodic basis.

Answer required for "I understand that CMS has a school counselor that each student visits on a periodic basis."

I understand

I understand that CMS does NOT have an ICT (Special Education) class.*

Answer required for "I understand that CMS does NOT have an ICT (Special Education) class."

I understand

Code of Conduct and Family Involvement

It is my understanding that Cornelia Connelly Center - Connelly Middle School (CMS) is committed to academic opportunities and open to spiritual and social development. Each student will be encouraged to work to her potential and to adhere to a Christian code of conduct. Families will be required to participate actively in the life of the school (including attendance at meetings, field trips, etc.) in order to meet the requirements of the program.

Signature*

Answer required for "Signature"

Date*

Answer required for "Date"

Attestation Statement

I affirm that the above information is true to the best of my knowledge. I understand that failure to provide the required documentation stops the application process. Furthermore, should my child be accepted/admitted under false or negligent information, my child will be dismissed from the school. I also agree that should my child be accepted/admitted, my child and I will be bound by the terms and conditions of the school's parent/student handbook. By typing my name below, I am signing and agreeing to the above statements.

Signature*

Answer required for "Signature"

Date*

Answer required for "Date"

Confirmation Email

Confirmation Email *

Answer required for "Confirmation Email"

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