F.C.A. §§301.2(17), 380.1(3) [Applicable to Respondents Placed Pursuant to F.C.A. §353.3 with the NYS Office of Children and Family Services] FAMILY COURT OF THE STATE OF NEW YORK COURT OF _____________________________ In the Matter of Name: Date of Birth: Form 3-47 (Juvenile Delinquency) 1/2001 Docket No. NOTICE OF PLACEMENT A Person Alleged to be a Juvenile Delinquent Respondent. _________________________________ TO: Designated Educational Official [Specify]:1 __________________________________ School District and School [Specify, if available]: PLEASE TAKE NOTICE that _______________________________, the Respondent in the above-entitled proceeding, was adjudicated a juvenile delinquent by this Court and was placed with the New York State Office of Children and Family Services pursuant to Family Court Act §353.3 for a period of [specify duration]: _______________________ on [specify date]: _______________________. CLERK'S CERTIFICATION I, , (Deputy) Clerk of the Family Court the State of New York, County, do hereby certify that the above information is an accurate summary of the records of this Court. ___________________________________ (Deputy) Clerk of the Family 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 FAMILY COURT ACT §301.2 TO RECEIVE SUCH NOTICES OF PLACEMENT AND MAY BE USED SOLELY FOR THE PURPOSES SPECIFIED IN FAMILY COURT ACT §§301.2(17), 380.1. 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 THE ADJUDICATION EXCEPT BY ORDER OF THE FAMILY COURT. 1The Designated Education Official for all public schools 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 . 2001 © American LegalNet, Inc.