• DYCD Universal Participant Intake: Youth Application

    (13 Years and Younger)

  • Welcome to the Department of Youth and Community Development DYCD. This form lets you or your child apply to a DYCD Comprehensive Afterschool System (COMPASS), Beacon or Cornerstone youth program. You can only submit one application per person per location. Submitting a form does not guarantee eligibility or enrollment in the program and we might ask for more information to see if you are eligible. If accepted, the program will not cost you anything. We collect some information like Gender, Race, Ethnicity, Language, and Health Insurance status for planning purposes only. Your answers to these questions will not affect your status to benefits or services and will not be shared outside of DYCD without your permission. Income, Household Information, and Education/Work status might affect eligibility for certain programs. Gathering your information helps DYCD see who benefits from our programs. This helps us make our programs better and allows DYCD to continue giving communities the support they need.

  • Part I: Applicant Information

  • For the purposes of this application, applicant refers to the person applying to receive services. Please select one*
  • How well does the applicant speak English? (Select One):*
  • Applicant’s Sex at Birth (Select One)*
  • Applicant’s Race/Ethnicity (Select all that Apply):*

  • Is the applicant any of the following:

  • An Individual with a Disability?*
  • Parent/Legal Guardian?*
  • Offender/Justice Involved?*
  • Foster Care Participant?*
  • Runaway youth?*
  • Veteran?*
  • Active Military Personnel?*

  • DYCD Universal Participant Intake: Youth Application (13 Years and Younger)

  • If of Native Hawaiian or Other Pacific Islander origin, please select from the following (Select All That Apply):
  • If of Asian origin, please select from the following (Select All That Apply):
  • If of Hispanic or Latinx/e/a/o origin, please select from the following (Select All That Apply):
  • Applicant's Primary Language (Select One):*
  • Other Languages Spoken by Applicant (Select All That Apply):
  • Did you or any member of your household serve in the armed forces, national guard, or reserves of the United States?*
  • If yes, would you or your household member want to be contacted by the NYC Department of Veteran's Services?
  • Would the applicant like to receive information/ be contacted about registering to vote?** (Select One):*

  • *Applicant is eligible to vote in U.S. federal elections if: 1) You are a U.S. citizen; 2) You meet your state’s residency requirements; 3) You are 18 years old. Some states allow 17-year-olds to vote in primaries and/or register to vote if they will be 18 before the general election. Check your state’s voter registration age requirements.

  • If the applicant is an individual with a disability, please select disability type(s) (Select all that Apply):*

  • DYCD Universal Participant Intake: Youth Application (13 Years and Younger)

  • How did you learn about the DYCD program(s) you’re applying to?(Select all that apply)

  • How did you learn about the DYCD program(s) you’re applying to?(Select all that apply)*

  • Part II: Applicant's Contact Information

  • Format: (000) 000-0000.
  • Phone Number #1*
  • Format: (000) 000-0000.
  • Phone Number #2
  • Preferred Method of Contact*

  • Parent/Guardian's Contact Information: This section is required for Applicants under 18

  • Format: (000) 000-0000.
  • *
  • Preferred Method of Contact*

  • Part III: Emergency Contact Information

  • Format: (000) 000-0000.
  • Format: (000) 000-0000.
  • *

  • DYCD Universal Participant Intake: Youth Application (13 Years and Younger)

  • This section is for Parents/guardians enrolling their children

    Emergency contacts listed in Section III are authorized to pick up the child unless otherwise noted.

    The following additional people are authorized to pick up my child:

  • Format: (000) 000-0000.
  • Format: (000) 000-0000.
  • Format: (000) 000-0000.

  • The following people MAY NOT pick up my child:

  • Part IV: Applicant’s Education/Work Status

  • Applicant’s School Type (Select One)*
  • **If applicant is a Part-Time Student or Full-Time Student: Please select applicant’s current grade (Select One):  ***If applicant is Not in School: Please select the last grade completed by the applicant (Select One):*
  • Applicant's current work status*

  • Required for Full-Time Students

  • School Type

  • Part V: Household Information

  • For all the next set of questions, HOUSEHOLD is defined as: any individual or group of individuals (family or non-family members) who are living together as one economic unit. INCOME is defined as the total annual gross income of all family and non-family members 18+years old living within the household.

  • The applicant lives in a household that is headed by (Select One)*
  • Applicant's Housing Type (Select One):*
  • Applicant’s Household Size (Select One)
  • Sources of Applicant’s Household Income: (Select all that Apply):

  • Part VI: Applicant’s Health Information

  • Does the applicant have health insurance? (Select One):*
  • If yes, what kind of health insurance does the applicant have? (Check all that Apply)
  • If you do not have health insurance, do you want to be contacted by someone else with information about signing up for public health insurance? (Select One)
  • If you would like to be contacted about signing up for public health insurance, what is your preferred method of contact? (Select One)

  • Please answer the questions below and provide additional details in the space provided.

    Many needs or health challenges can be accommodated and may not limit enrollment in the program.

  • Does the applicant have any allergies e.g., food, medication, etc?*
  • Does the applicant have asthma?*
  • Does the applicant have special health care needs?*
  • Does the applicant take medication for any condition or illness?*
  • Are there activities the applicant cannot participate in?*

  • Part VII: Consents and Signatures

  • Pick-up/Dismissal Information

    This question must be answered for parents/guardians enrolling their children
  • My child has permission to travel home alone at dismissal:*

  • Consent to Participate

  • To the best of my knowledge the information above is true. I agree to its verification and understand that falsification may be grounds for termination of service. Information provided may be used by the City of New York to improve City services and access to those services, and to access additional funding.

    If participant is 18 and over:

  • I acknowledge that I am 18 years of age or older and am authorized to give consent.
  • Date
     / /
    2 digit month, 2 digit day, 4 digit year

  • If participant is under 18 years old:

  • Date*
     / /
    2 digit month, 2 digit day, 4 digit year

  • Consent for Emergency Medical Treatment

  • If participant is 18 and over

  • I am enrolled as a participant in a DYCD-funded program. In the event of a medical emergency, I hereby give consent for necessary emergency medical treatment to be obtained on my behalf. I further authorize the emergency contact(s) listed to be contacted.
  • Date
     / /
    2 digit month, 2 digit day, 4 digit year

  • If participant is under 18 years old:

  • My child is enrolled as a participant in a DYCD-funded program. In the event of a medical emergency, I hereby give consent for necessary emergency medical treatment for my child to be obtained, with the understanding that I will be notified as soon as possible. I understand that every effort will be made to contact me, or, if I am unavailable, the emergency contact(s) listed, before and after medical care is provided.*
  • Date*
     / /
    2 digit month, 2 digit day, 4 digit year

  • Consent for Photography/Videotaping and Use of Original Work

  • As a participant enrolled in a DYCD-funded program, please be aware that from time to time DYCD and the City of New York, its contracted providers, authorized agents, third-party organizations with which it collaborates, or other government, representatives collectively, “Authorized Parties” may be present during program activities and special events associated with program services, both at the usual program location and at off-site events. In some cases, they may photograph, videotape, interview or otherwise record participants and their families and friends in these programs. The resulting images, videos, and interviews may be used, with or without the participant’s name, in printed and electronic media such as brochures, books, print and email newsletters, DVDs and videos, websites, social media and blogs collectively, “Media” I hereby authorize and permit the Authorized Parties, without compensation and without further approval, to photograph and/or record my and my child’s image, name, likeness, and the sound of my and my child’s voice during DYCD-funded program activities and special events, and I hereby consent to the resulting images, videos and interviews being used, without compensation and without further approval by the Authorized Parties solely for non-profit, non-commercial purposes in any and all Media.*
  • If, in the course of participating in DYCD-funded program activities and special events, any original work such as art, music, choreography, poetry, or prose (collectively, “Original Work”) is created by me or my child, I hereby consent to such Original Work being used by the Authorized Parties, without compensation and without further approval, solely for non-profit, non-commercial purposes in any and all Media.*

  • If participant is 18 and over:

  • I acknowledge that I am 18 years of age or older and am authorized to give consent.
  • Date
     / /
    2 digit month, 2 digit day, 4 digit year

  • If participant is under 18 years old:

  • Date*
     / /
    2 digit month, 2 digit day, 4 digit year

  • Parent/Guardian Consent to Collect and Share Student Information

  • The Department of Youth and Community Development (DYCD) provides funding for this program as part of its mission to help you assist your child reach his or her full potential. Many of our programs are run by community-based organizations. We work to make sure the services you and your children receive are of the highest quality. DYCD is requesting your permission to allow us to collect information we need on your child, their participation and the quality of the services provided.

    What information from your child’s student records is DYCD requesting?

    We are requesting your permission for the New York City Public Schools (NYCPS) to share personally identifiable information from your child’s student records with DYCD. The information we would like to collect consists of biographical and enrollment information (specifically consisting of your child’s name, address, date of birth, student identification number, grade, school(s) attended and transfer, discharge, and graduation data about your child); data concerning your child’s school attendance (including number of days attended and absences); and academic performance data (including your child’s results on state and national exams, credits earned, grades, promotion and retention status, and fitnessgram score); and data related to any disciplinary actions taken against your child (including number and type of suspensions).

    We are requesting to collect the information listed above about your child on a past, present and future (i.e., ongoing) basis.

    We are also requesting your permission for DYCD to share information we collect on the enrollment form from you and/or your child with NYCPS staff. The information includes registration information, student’s interests and challenges, type of program enrolled-in and frequency of participation. This information will be used to help the school and community organization work together to meet you and your child’s needs.

    Who will see my child’s information and how will it be safeguarded?

    The only people who will see your child’s individual information are DYCD and NYCPS staff who manage the data systems and prepare research reports and program analyses. The limited number of DYCD staff identified to receive personal information is screened, and provided extensive training to follow strict guidelines on protecting the confidentiality of information that would personally identify you or your child. Personally identifiable information collected from student records will only be shared electronically between NYCPS and DYCD and will be secured and protected in the DYCD database. Personally identifiable information will not be shared with any community-based organizations or their staff members. We will not use your name or your child’s name in any published report. While we request your consent, your responses to the below requests will not affect your child’s participation in DYCD sponsored programs.

     

    Please check Yes or No to each of the following statements:

  • I understand why DYCD is asking my permission to access the information listed above from my child’s student records, and I give permission to NYCPS to share that information with DYCD on an ongoing basis.*
  • I understand why DYCD is asking my permission to share information about my child collected by DYCD with NYCPS staff and I give my permission to DYCD to share information with NYCPS on an ongoing basis.*
  • Date*
     / /
    2 digit month, 2 digit day, 4 digit year

  • Consent to Make Referrals and Share Information

  • The New York City Department of Youth and Community (DYCD) invests in programs and services to help our communities and the people who live here. We want to make sure you know about them and make it easy for you to apply.

    Why we need your consent

    With it, we can:

    • decide if you are eligible for services;
    • send you information about DYCD-funded programs and services you can apply for;
    • send you information about research activities, focus groups, and surveys related to program improvement;
    • share information from your DYCD Participant Application with the programs you apply for; and
    • track the results of the services you receive.

    What we share

    We’ll only give information to show you qualify or help you enroll in DYCD-funded programs.

    Who sees your information and how we protect it

    Only authorized employees at DYCD and the programs DYCD funds can see it.

     

    Please read below, check one of the boxes, and fill in the rest.

    I understand that DYCD needs my consent to:

    • decide if I am eligible for services;
    • send me information about programs and services I can apply for;
    • refer me to DYCD-funded programs;
    • send me information about research activities, focus groups, and surveys related to program improvement;
    • share information from my DYCD Participant Application with the programs I apply for; and
    • track the results of the services I receive.
  • *
  • Date*
     - -
    2 digit month, 2 digit day, 4 digit year

  • Parent Involvement

  • Format: (000) 000-0000.
  • Format: (000) 000-0000.
  • Format: (000) 000-0000.
  • I would like to support New York Edge programs by (Check areas of interest):

  • Certification Statement

  • I certify that all information on this form is true and correct. I understand that my statements are subject to verification. I agree and accept that I will abide by all applicable rules and regulations of this program. I consent to the enrollment and participation of the child listed above in this program.

  • Date*
     / /
    2 digit month, 2 digit day, 4 digit year
  • Date*
     / /
    2 digit month, 2 digit day, 4 digit year

  • WAIVERS AND CONSENTS

  • I, the undersigned, certify that I am the parent or legal guardian, that I have read the consents outlined above and give my participant permission to participate in the New York Edge program.

  • Date*
     - -
    2 digit month, 2 digit day, 4 digit year

  • Parent Consent to Participate in the Evaluation of the After-School Program

    Your child, is enrolled in the after school program at, to monitor the effectiveness of the after school program and ensure its future success, New York Edge is conducting ongoing evaluations. It is the intention of the evaluations to learn how these services help students and how they can be improved in order to meet funding requirements.

     

    Specifically we ask permission from parents to:

    • Talk to teachers and after-school staff about children’s progress and participation in the after-school program, and review program records on participationin the after-school program.
    • Survey and/or interview parents and children about the after-school program and its effects. There will be a survey distributed via text/email over the course of the year. The survey will take approximately 15 minutes. Group discussions may also be held, that would take up to 30 minutes.

    Any information we collect will be used only to assess the after-school program and will not be made public. Participation in the evaluation is completely voluntary, and participants may withdraw at any time without consequence. Personal information will not be used for any purposes after the evaluation is complete.

     

     

    Please select ONE of the options below and return this form to the program coordinator/director.

     

  • *

  • Parent/Guardian Data Release Consent Form

  • I. Information being requested.

    New York Edge is requesting your permission to collect acadmic performance and enrollment data on your child. This information will be used for the purposes of establishing proramout comes and may be used in a combined, not individualized, format to help advocate for continued funding.

    Contact their children’s school and obtain records showing their progress, including report cards, grades, citywide and statewide test scores, attendance, school choice, and any other reports pertaining to academic progress. Biographical and enrollment information (specifically consisting of your child’s name, address, date of birth, student identification number, grade, school(s) attended and transfer, discharge, and graduation data about your child) Data concerning your child’s school attendance (including number of days attended and absences) Academic performance data (including your child’s results on state and national exams, credits earned, grades, promotion and retention status, and fitness gram score) Data related to any disciplinary actions taken against your child (including number and type of suspensions)

    II. How will your child’s data remain confidential?

    We will not use your name or your child’s name inany published report. While we request your consent, your responses to the requests below will not affect your child’s participationin our programs.

     

    Please check Yes or No to the following statement:

    • I understand why New York Edge is asking my permission to access the information listed above from my child’s student records, and I give permission to DOE to share that information with New York Edge on an ongoing basis.
  • *

  • EMERGENCY MEDICAL CARE FORM

    (To be completed by the parent or guardian)
  • Date of Birth:*
     - -
    2 digit month, 2 digit day, 4 digit year

  • 1.I authorize New York Edge (“Program”) to, if necessary, provided basic first aid in accordance to their level of training. Injury assessment and intervention will include the use of topical skin antibiotic as appropriate.

    2.If my child requires emergency medical care as determined by an appropriately trained employee of the Program, I give my consent to the above Program to obtain the necessary medical care for my child. I agree to pay all of the costs associated with the emergency medical care that my child receives.

    3.I hereby release the Program from any and all claims which I or my child may have against New York Edge arising from or in connection with the providing of First Aid as described herein, except where due to the negligence of New York Edge staff. This agreement is signed for the purpose of fully and completely releasing, discharging, and indemnifying the program from all liability as described herein.

    4.Following emergency medical care, my child may be released to the following people:

  • Format: (000) 000-0000.
  • Format: (000) 000-0000.
  • Format: (000) 000-0000.
  • Format: (000) 000-0000.
  • Format: (000) 000-0000.

  • 5. Health Information:

  • Format: (000) 000-0000.

  • 6.I understand that this consent will be in effect as of the date of my signing this form and will continue as long as my child is enrolled in the Program.

  • Date*
     / /
    2 digit month, 2 digit day, 4 digit year

  • Universal Social Emotional Learning Supports & Assessment

    Parent/Guardian Consent Form


    To be completed by parent/guardian of student participating in NYE programming

    Purpose & Procedures:

    New York Edge is committed to supporting the social, emotional, behavioral, and overall well-being of every student participating in its after-school and youth development programs.As part of its program model, New York Edge provides universal Social Emotional Learning (SEL) programming and support to all participating students. SEL supports are designed to help students develop skills in the five core CASEL competencies: self-awareness, self-management, social awareness, relationship skills, and responsible decision-making. New York Edge uses a tiered framework of SEL supports to respond to the range of social emotional needs that students may experience. All students receive universal SEL opportunities, while some students may receive additional targeted or individualized supports based on identified needs.

    Mosaic By ACT Assessment - Privacy and Use of Information:

    New York Edge will use the Mosaic by ACT Social Emotional Learning Assessment as part of its universal SEL framework. Mosaic is designed to measure five social-emotional skills: Sustaining Effort, Getting Along with Others, Maintaining Composure, Keeping an Open Mind, and Social Connection. Strengthening these skills directly supports the development of the five core CASEL competencies: self-awareness, self-management, social awareness, relationship skills, and responsible decision-making. Mosaic assessment information may be used by authorized New York Edge staff to identify students’ SEL strengths and areas for growth, inform and improve SEL programming and student supports, better understand and respond to student needs, monitor changes in students’ SEL skills and outcomes over time, conduct program evaluation and quality improvement, and meet applicable grant, funding, reporting, and program requirements. Student assessment information will be maintained and shared in accordance with applicable federal and state laws, regulations, and New York Edge policies. When information is used for program evaluation, reporting, or grant purposes, NYE may use aggregate or de-identified information when appropriate so that individual students are not identified. Mosaic is a social emotional learning assessment and is not a clinical mental health assessment. If a student's needs indicate that additional clinical support may be appropriate, NYE may communicate concerns with the student's parent/guardian and discuss available resources or referrals.

     

    Referrals & Coordination of Care:

    New York Edge may identify students who could benefit from additional support beyond the scope of the SEL programming provided within the program. When appropriate, NYE may discuss identified concerns with a parent/guardian, provide information about available mental health or community based resources, recommend or facilitate a referral to an external licensed provider, and support families in navigating available services. Parent/guardian consent will be obtained before a student is referred to an external mental health provider or agency for clinical services or before NYE engages in clinical coordination of care that requires parent/guardian authorization. New York Edge does not provide psychiatric evaluation, diagnosis, psychotherapy, or long-term clinical mental health treatment through its SEL programming. Clinical diagnosis and treatment, when needed, are provided by independent licensed mental health professionals or agencies. A separate Clinical Supports Coordination of Care Parent Consent Form may be provided when a student may benefit from external clinical services or coordination of care.


    Risks & Benefits:

    Potential benefits of participating in NYE's SEL assessment and support framework include increased understanding of students' social-emotional strengths and areas for growth, improved opportunities to develop social-emotional skills, earlier identification of areas where additional support may be beneficial, and improved coordination of appropriate resources when needed. Potential risks include the possibility that assessment information may identify areas of concern or need. There may also be limited disclosure of student information to authorized NYE staff for purposes of providing, evaluating, and improving SEL supports. New York Edge will make reasonable efforts to protect the privacy and confidentiality of student information in accordance with applicable laws and organizational policies.


    Voluntary Participation & Consent:

    I understand that New York Edge will use the ACT Mosaic SEL Assessment as part of its universal SEL framework. I understand that the assessment is intended to measure social-emotional skills and inform SEL programming and student supports and is not a clinical mental health evaluation or diagnostic assessment. I understand that this consent does not authorize New York Edge to provide clinical mental health treatment or to release my child's information to an external mental health provider for clinical services. If my child is identified as potentially benefiting from external clinical services or clinical coordination of care, New York Edge will obtain separate parent/guardian consent as appropriate.

    Universal Social Emotional Learning Supports & Assessment
    Parent/Guardian Consent Form
    To be completed by parent/guardian of student participating in NYE programming

    Questions About SEL Supports:

    If you have questions about New York Edge's SEL programming, student supports, or the ACT Mosaic assessment process, please contact your New York Edge program representative or the New York Edge Leadership & SEL Department.

     

  • Type a question*
  • Date*
     - -
    2 digit month, 2 digit day, 4 digit year

  • Letter to Council Member to help New York Edge


    March 2027


    Dear Council Member:

    Thank you for the Council’s longstanding support of New York Edge, Inc. (NYE). For over 30 years the New York City Council has partnered with New York Edge in providing FREE school-based afterschool and summer programming across the city that is welcoming, enriching and fun. As a parent whose child participates in NYE programming, I have seen first-hand the benefits – academically, physically and emotionally – that this programming offers.

    New York Edge sports, arts, recreation and academic programming is on par with the best private pay enrichment programs in the city. Its programs are culturally relevant, tailored to students’ needs and interests, and rooted in social-emotional learning. Its staff are engaged, caring and committed to the students they serve.

    Continued funding of NYE by the Council in the upcoming budget is vital to my child, the children of our community and to thousands of youngsters throughout the five boroughs.

    As your constituent, I ask that you advocate for New York Edge and fight on behalf of its FY 28 citywide funding requests.

    Thank you.

  •  
  • Should be Empty: