N.Y. Comp. Codes R. & Regs. tit. 22, subtit. D, ch. VI, form Criminal Form 6
Criminal Procedure Law §§ 380.90; 720.35(2), 720.35(3) [Applicable to Defendants Under the Age of 19 Who Are Criminal Form 6 Sentenced for Crimes or Adjudicated as Youthful Offenders 2/2001 and were enrolled in school at the time of sentence]
_____ COURT OF THE STATE OF NEW YORK
COUNTY OF ______________
_________
People of the State of New York
Against
Indictment/Docket No.
Name:
Date of Birth:
Defendant NOTICE OF CONVICTION OR YOUTHFUL OFFENDER ADJUDICATION ____________
TO: Designated Educational Official [Specify Name]:1________ School District and School [Specify, if available]: ________
PLEASE TAKE NOTICE that ______, the Defendant in the above-entitled proceeding, was [check applicable box]:
convicted by this Court of the following crime(s) [specify]: _________________________
adjudicated a Youthful Offender by this Court
and was sentenced as follows [specify]:
_______________________________________________________
on [specify date]:
_______________________________________________________
CLERK'S CERTIFICATION
I,
_______________________________________________________
, (Deputy) Clerk of the
_______________________________________________________
Court the State of New York,
County, do hereby certify that the above information is an accurate summary of the records of this Court.
Date: ____
_______________________________________________________
_______________________________________________________
(Deputy) Clerk of the
Court
NOTICE
THIS NOTICE IS CONFIDENTIAL. IT MUST BE KEPT SEPARATE AND APART FROM THE STUDENT'S SCHOOL RECORDS AND MUST NOT BE APPENDED TO OR INCLUDED IN ANY DOCUMENTATION RELATING TO THE STUDENT. IT MUST BE DESTROYED WHEN THE STUDENT IS NO LONGER ENROLLED IN THE SCHOOL DISTRICT. IT MAY BE ACCESSIBLE ONLY TO THE EDUCATIONAL OFFICIAL DESIGNATED BY THE SCHOOL DISTRICT PURSUANT TO CRIMINAL PROCEDURE LAW § 380.90(1) TO RECEIVE SUCH NOTICES AND MAY BE USED SOLELY FOR THE PURPOSES SPECIFIED IN CRIMINAL PROCEDURE LAW §§ 380.90 (2), 720.35(2), 720.35(3). IF THE STUDENT HAS BEEN ADJUDICATED A YOUTHFUL OFFENDER PURSUANT TO ARTICLE 720 OF THE CRIMINAL PROCEDURE LAW, THE DESIGNATED EDUCATIONAL OFFICIAL SHALL HAVE ACCESS SOLELY TO THIS NOTICE AND SHALL NOT HAVE ACCESS TO ANY OTHER OFFICIAL RECORDS OR PAPERS PERTAINING TO SUCH ADJUDICATION.
Footnotes
1 The Designated Educational Official for all public school in New York City is Lillian Garelick, Director of Attendance Services, Division of Student support Services, NYC Board of Education, 110 Livingston Street, Room 506B, Brooklyn, NY 11201; Fax: 718-935-3356; e-mail: lgareli@nycboe.net
N.Y. Comp. Codes R. & Regs. tit. 22, subtit. D, ch. VI, form Criminal Form 6