New York City Department of Education + Common Sense Media
CIPA Submission Form

New York City DOE Common Sense Media CIPA Toolkit

 
Thank you for selecting Common Sense Media's resources to meet CIPA requirements at your school. By completing this form, you are agreeing to download Common Sense's CIPA Toolkit. You will able be to view and download the CIPA Toolkit when you click submit at the end of this form.

Please note that the NYC DOE has requested that only school principals complete this form. All the information requested below must be provided, and will be shared
with the NYC DOE.

Beyond the NYC DOE, Common Sense Media may aggregate information that you provide but in such a manner that you (and your school) are not personally identifiable. For example, we may share with a foundation the total number of schools in New York City that submitted a form.

Contact schools@commonsense.org with any questions.

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1. Principal first name
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2. Principal last name
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3. Principal email address
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4. Principal employee ID #
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5. School ID #
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6. School name
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7. School street address
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8. School city
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9. School zip code
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