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CMS Admissions Application Part One

Please complete the form below. Required fields marked *

Read all instructions before submitting your application.

Incomplete applications will not be accepted.

Please note that you cannot save the application online.

A Word version of the application is available here. Applications may be submitted through this online form or typed in the Word file.
Una aplicacion en Español esta disponible aquí.
In addition to the application, you must supply the following documents by emailing them to admissions@connellycenter.org or mailing to
Admissions
Cornelia Connelly Center
220 East 4th Street
New York, NY 10009
  • Copy of student’s birth certificate
  • Completed 2017 tax return (form 1040) and last two pay stubs
  • Proof of Social Security benefits or Public Assistance (if applicable)
If you have questions, please contact admissions@connellycenter.org

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

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

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

Mother

Father

Guardian (if applicable)

Please check all that apply
Answer Required

Religious Affiliation (optional)

Ethnic Background (optional)
Answer Required

Household Information

Income Information

CCC is committed to serving students who are most in need of our program. As such, we ask parents/guardians to disclose income information as part of the application process. Currently, 90% of our students qualify for the federal Free/Reduced lunch program.

Monthly Income

Mother

Father

Other Adult Supporting Child

Student Description

Parent/Guardian Signature

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

I understand that CMS has a mandatory new student orientation July 8-12, 2019 at Cornelia Connelly Center*
Answer Required
I understand that part of her acceptance is to attend a mandatory sleep-away camp in Lake Placid, NY for 3 weeks each summer starting at the end of her 5th grade year.*
Answer Required
I understand that CMS 4th and 5th grades dismiss at 3:00pm, Monday - Thursday. On Fridays, dismissal is at 1:00pm.*
Answer Required
I understand that CMS has a school counselor that each student visits on a periodic basis.*
Answer Required
I understand that CMS does NOT have and ICT (Special Education) class.*
Answer Required

Code of Conduct and Parental Involvement

It is my understanding that Cornelia Connelly Center - Connelly Middle School 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.

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.

Policy of Non-Discrimination

Cornelia Connelly Center - Connelly Middle School admits students of any race, color, creed or national origin to all rights, privileges 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 administrated programs.

Confirmation Email