Special Education

STATE-OPERATED SCHOOL PHC-10

APPLICATION TO THE COMMISSIONER OF EDUCATION FOR APPROVAL FOR AN EVALUATION TO ATTEND A STATE-OPERATED SCHOOL PHC-10 - Word Word Document (52 KB)  PDF PDF icon (78 KB)

STATE-OPERATED SCHOOL PHC-10Spanish Word (47 KB) Word Document   Spanish PDF PDF icon (62 KB)

Updated October 2015

Application Instructions for PHC-10 Application to the Commissioner of Education for Approval for an Evaluation to Attend a New York State-Operated School

  1. Please print or type the information on the attached application; Word and PDF versions are posted above. 

  2. Submit the following medical documentation with the attached application:

For a child who is Blind (a minimum of one of the following documents must be submitted)

  • Current ophthalmologic examination (administered within the last 12 months)
  • New York State Commission for the Blind and Visually Handicapped (CBVH) report indicating legal blindness

For a child who is Deaf:

  • Current audiogram (administered within the last 12 months)
  1. Submit the following school/educational information with this application (if available; if your child is currently in a preschool or school age program for children with disabilities):
  • Current Individualized Education Program (IEP)
  • Physical examination report
  • Psychological exam/report
  • Social History
  • Any additional appropriate information

Application Submission Information

While electronic submissions are preferred, NYSED’s e-mail server cannot guarantee secure transmittal of email messages at this time.  Please consult with your Information Technology staff and if your e-mail server allows for transmitting electronic messages securely via Transport Layer Security (TLS) protocols, you can submit applications electronically.  If you cannot send an e-mail securely via TLS, in order to protect student confidential information, you must mail or fax the application. Select one method for submission (e-mail or mail or fax).

Email (if transmitting via TLS):
NYSSBNYSSD@nysed.gov

OR
Mail to:

New York State Education Department
Special Education Quality Assurance
Nondistrict Unit, Room 309 EB
89 Washington Avenue
Albany, New York 12234
Attn: State-operated PHC-10 application

OR
Fax: (518) 473-5769

For further assistance in completing this application, please contact the Nondistrict Unit at (518) 473-1185 or NYSSBNYSSD@nysed.gov.

Last Updated: November 13, 2015