APPLICATION FOR NONPUBLIC SECONDARY SCHOOL REGISTRATION

          Attached is a form to be used by nonpublic school authorities in making application for the registration or admission of a secondary school to the University of the State of New York. Secondary schools which are registered are granted the privilege of administering Regents examinations and awarding diplomas.
         Complete information should be given under each heading and under each subdivision.
Once the attached application has been received, it will be reviewed to determine the degree to which the applicant school is in compliance with applicable laws, and regulations. In addition, Department staff will review data concerning student achievement. Once the application is complete, a member of the professional staff will visit the school. Following this, a recommendation will be submitted to the Board of Regents.
         Correspondence relative to this application, along with requests for technical assistance, should be addressed to: Office of Nonpublic School Services, New York State Education Department, Room 481 EBA, Albany, New York 12234. The telephone number is: (518) 474-3879.

Name of School

   

Address

   

BEDS Number

   

Grade Levels

   
Name of Principal or Head   
Phone   

 Complete the following if applicable: 

Date/No. of Charter      
Type of Charter   
Other Type of Incorporation   
Religious Affiliation   

PART A: DESCRIPTION OF SCHOOL

 Please provide a description of the school in narrative form addressing the topics listed below. If appropriate, attach a copy of the school brochure or catalog.

PART B: COMPLIANCE WITH APPLICABLE LAWS, RULES AND REGULATIONS

This section allows both the secondary school and the State Education Department to determine the extent to which the school meets the requirements established by the Education Law (Ed.L), the Regulations of the Commissioner of Education (CR) and other relevant laws. The basis for each law or regulation is cited at the end of each statement.

Check the appropriate response below each statement to indicate whether or not your school is in compliance. If the answer to any question is No, please explain in the space to the right under "Comments." 

       

Comments
1. Has each pupil been immunized against poliomyelitis, rubella, diphtheria, mumps and measles? Public Health Law 2164 Yes No  
2. Are daily attendance records maintained? Ed.L., 3211(4) Yes No  
3. Is instruction provided in patriotism and citizenship; the significance, meaning and effect of the Constitution of the United States, the Declaration of Independence, and Constitution of New York State? Ed.L., 801; CR 100.2(c)(1) and (2) Yes No  
4. Are the following subjects or their equivalent offered: CR 100.5      
  English............................... 4 units Yes No  
  Social studies .................... 4 units
(including a year of American history)		 Yes No  
  Mathematics....................... 2 units Yes No  
  Science............................... 2 units Yes No  
  Health education.................. 1/2 unit Yes No  
  Physical education................ 2 units Yes No  
  Art and/or music.................. 1 unit Yes No  
5. Have the sequence requirements been met? CR 100.5(c) Yes No  
6. Have courses offered for Regents diploma credit, for which there is no State syllabus, been approved by the State Education Department? CR 100.5(b)(6)(ii) Yes No

[     ]  N/A
7. Does the school ensure that students are not denied membership or participation in any curricular or extracurricular activities on the basis of race, sex, marital status, color, religion, national origin, or disability, except as otherwise provided in the regulations? CR 100.2(k) Yes No  
8. Has a statement of nondiscrimination been made available? IRS Code 501 (c)(3) Yes No  
9. Does the School provide a guidance and counseling program? CR 100.2(j)(2) Yes No  
10. Has the school developed and implemented plans for providing physical education experiences for all pupils? CR 135.4 Yes No  
11.

Many schools integrate safety education instruction with other curricula. Please provide a description of how the following instruction is covered:

      
 

Does safety education include highway, traffic, bicycle, home, recreational, industrial, occupational and school safety? Ed.L, 806; CR 100.2(c) and CR 107.1(a)

 Yes No  
 

Is instruction in safety education provided for not less than 30 periods, or the equivalent, in each of grades 7-9? CR 107.1

 Yes No  
 

Does the school provide instruction in safety education for not less than 15 periods, or the equivalent, in each of grades 10-12? CR 107.1(a)

 Yes No  
12.

Is instruction in fire and arson prevention given for a minimum of 45 minutes each month or the equivalent? (Please provide a description of how this instruction is covered in the curriculum.) Ed.L. 808

 Yes No  
13.

Does the health education program include instruction concerning the misuse of alcohol, tobacco and other drugs; and instruction concerning AIDS? Ed.L., 804 and 804-a

 Yes No  
14.

Do students wear appropriate eye safety devices in shops and laboratories when activities present a potential eye hazard? Ed.L., 409-a; CR 141.10

 Yes No  
15.

If the school uses hypodermic needles and syringes for educational purposes, has the school filed a certificate of need with the State Education Department? CR 137.1

 Yes No

[     ] None Used
16.

Have all pupils who received a Local Diploma or a New York State (Regents) diploma met the requirements set by CR 100.5. (These requirements vary depending on the year of entry into 9th grade).

 Yes No

 
17.

Are all students entering for the first time with no available records (math, reading and writing) screened to determining the need for remedial instruction? CR 100.2(r)(1)

 Yes No

[     ]  N/A
18.

Are pupils who score below the reference point on the Regents preliminary competency tests and Regents competency tests provided appropriate remedial instruction? CR 100.4(e) and 100.5(a)(4)(iii)

 Yes No

[     ]  N/A
19.

Does the principal notify in writing the parent or guardian of a student who shall be provided remedial instruction of the competency test results and the plan for remedial instruction? CR 100.4(e) and 100.5(a)(4)(iii)

 Yes No

[     ]  N/A
20.

Has the Comprehensive Assessment Report (CAR) report been made available to parents upon request? CR 100.2(m)(2)

 Yes No  

21.

 Is a school library maintained? CR 91.1 Yes No  
22.

Does the school library contain the minimum number of titles required for the average daily attendance (A.D.A.) of pupils, as follows?  CR 91.1

      
 
ADA Titles
200-500 3,000
501 - 1,000 5,000
1,001 - 8,000
Yes
Yes
Yes
No
No
No
 
23.

If the school awards certificates to students with handicapping conditions,

    

[     ] None Awarded
 

a) has the school adopted written policies and procedures so that, prior to awarding local certificates, such students are ensured appropriate opportunities to earn a high school diploma? CR 100.6(a)

 Yes No  
 

b) Are certificates awarded only to students who have achieved the educational goals specified in each student's IEP in effect during the year in which such certificate is awarded? CR 100.6(b)(1)

 Yes No  
 

c) Is each certificate accompanied by a written statement of assurance that the student continues to be eligible to attend the public schools of residence until the student has earned a high school diploma or until the end of the school year of such student's 21st birthday, whichever is earlier? CR 100.6(c)

 Yes No  
24.

Are twelve fire drills conducted each school year and are eight of these drills conducted between September 1 and December 1 of each year? Ed.L., 807

 Yes No  
 

If the building has fire escapes, do at least one third of the drills involve use of the escapes? Ed.L., 807

 Yes No  
25.

Except for schools in New York City, is a fire inspection report filed annually with the New York State Education Department? Ed.L., 807-a

 Yes No  

PART C:   STUDENT COMPETENCY AND RETENTION RATES

STUDENT RETENTION

Compare the current senior class to the same group that started 9th grade three years ago. How many students have dropped out? Do not include students who have transferred to other schools, or students who have entered a General Equivalency Degree Program. If the school has a dropout problem, how is this being addressed?

No. of students in grade 12  
No. of students who have dropped out (between grades 9 and 12):  
% of students who have dropped out (between grades 9 and 12):

%

STUDENT COMPETENCY

Before graduating from high school, students must demonstrate competency on Regents Competency Tests (RCT), Regents Examinations, College Board's Scholastic Aptitude Tests (SAT) or American College Testing Program (ACT). Competency must be demonstrated by passing:

a. RCT in reading and in writing or the Regents Comprehensive Exam in English.
  (Competency in Reading can also be demonstrated by scoring 310 or higher on the Verbal subtest of the SAT; or by scoring 9 or higher on the Social Studies Reading; or by scoring 15 or higher on the Natural Sciences Reading subtests of the ACT.) (Competency in Writing can also be demonstrated by scoring 310 or higher on the Verbal subtest of the SAT or by scoring 12 or higher on the English Usage subtest of the ACT.)
  For 12th grade students, please complete the following:
 

Test Passed

No. of Students

% of Students
  RCT    
  Regents Exam    
  SAT    
  ACT    
  Total    
b. RCT in mathematics or a Regents examination in mathematics or business mathematics.
  (Competency in Mathematics can also be demonstrated by scoring 350 or higher on the Mathematical subtest of the SAT or by scoring 12 or higher on the Mathematics Usage subtest of the ACT.)
  For 12th grade students, please complete the following:
  Test Passed No. of Students % of Students
  RCT    
  Regents math    
  Regents business math    
  SAT    
  ACT    
  Total    
c. RCT in American History and government or the Regents exam in American History and government.
  (Competency in American History and government can also be demonstrated by scoring 410 or higher on the American History and Social Studies College Board Achievement Test (CBAT).
  For 12th grade students, please complete the following
  Test Passed No. of Students % of Students
  RCT    
  Regents Exam    
  CBAT    
  Total    

Person completing this form (Please type or print)

Name
Title
Phone

 

ADDENDUM -- APPLICABLE LAWS, RULES AND REGULATIONS

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