In order to make a referral, a worker from the sponsoring agency (County DSS, OCFS or school CSE) must supply us with the following information.  The downloadable form below includes this in checklist form. Caseworkers are encouraged to call the Admissions Department before making a referral.

  • A cover letter that includes:  DOB, gender, current location, contact information for caseworker, date of the disposition hearing (if disposition has already occurred, the date it occurred and the child’s disposition status, i.e. PINS, JD, A/N).
  • Documents characterizing the circumstances leading to placement (PDI, supplemental summary to the court, police reports).
  • Documents characterizing the child’s living circumstances and social history (PDIs and/or psychological evaluations are often sufficient; in their absence, please add a paragraph to the cover letter).
  • Current IEP (if classified) and current transcript or report card.
  • Discharge summaries from previous placements, psychiatric hospitals or rehabs.
  • Adjustment reports from detentions, if available.
  • Psychological and other evaluations (educational, substance abuse, neuropsychological, medical or psychiatric).
  • Psychiatrist’s reports indicating current diagnosis and treatment recommendations, including medications.
  • Medical documentation of any impairing conditions.

At the time of admission, more information is required, including the child’s immunization record, most recent medication administration record (MAR), as well as copies of the child’s birth certificate, Social Security card and insurance cards.  If the school transcript has not already been supplied, we need it at this point.

Inquire about a referral



The downloadable files below contain the packet of forms that need to be completed after a child has been formally accepted, and supplied to the Admissions Department at or before the scheduled admission.  The Case Manager form is for the case manager to complete; the rest are customarily completed by the family, though the Commissioner (or designee) is empowered to complete them as well.  Please supervise for completion of lines seeking information, not just signatures.  Also, please note that the VanClef Outpatient Chemical Dependency Program consents, while they appear similar, are a little different:  we need them all signed.  Many people miss the assignment of benefits section of the health insurance form, but that is important, too.



Admissions Department

Chris MacCormick
Director of Admissions

Nick Peters
Assistant Director of Admissions