Notice Of Intent To Home School Template Page 2
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1
2
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4TESTING: State law requires that home school students are
F I L E F O R M S E V E R Y Y E AR
: PART A AND B must be
2014-2015 School Year
tested. Students currently test in grades 3 through 9. The
returned to the Superintendent’s Office EACH YEAR no
(
Do not modify/revise ADE forms)
tentative test date for home school students will be in April of
later than August 15, or
by December 15 to begin home
2015. Please check the Home School Testing website for
schooling the second semester, or during the year with a 14-
District LEA # ___________(District use only)
more information at
calendar day waiting period.
Only
the Superintendent or local
Submit/Mail all forms to Superintendent’s Office ONLY
Parents/legal guardians that are registered for the current
School Board has the authority to waive the 14-day waiting period.
Check your local phone book or Arkansas Department
Please retain a copy of the completed form for your
school year will receive written notification of the test dates,
times, and sites later in the school year. Please contact the
Of Education website for district address
files.
Arkansas Home School Testing Office if you have questions
regarding testing at (501) 354-3136
Notice of Intent to Home School
Arkansas Department of Education-Home School Office (501) 682-1874
PART A – Please print
(forms must be legible to be accepted)
In accordance with the procedures established for the implementation of Ark. Code Ann. § 6-15-501 et seq., I/we hereby give notice to _____________________, Superintendent of the
_________________________________________ School District, _________________ County, of my/our intent to provide home instruction to my/our own child(ren) located at:
_____________________________________________________, ______________________________, AR
, beginning date for
2014-2015
.
Print or Type Parent’s Address
City
Zip
(start date - Month/Day/Year)
Parent’s mailing address if different from above:
(for mailing test notification/results)
Further, I/we agree that my/our child(ren) will take a nationally recognized standardized achievement test as required in A.C.A. 6-15-504. The test will be administered to home school students in
grades 3 through 9 during the testing window for the current school year. The Arkansas Department of Education recommends that you notify the local school district of any change of address or if
you discontinue to home school. In order to maintain legal home school status, current year forms must be filed every year by the established deadlines. During the school year, new forms must be
submitted within 30 days of the parent(s) moving to a new school district.
_(____ _)________________ _
________________________
_______________
PRINT name of
parent/guardian
Phone Number
(Optional)
Occupation
(Optional)
Today’s Date
Student Information:
Name of School Last Attended:
GRADE LEVEL
PRINT or TYPE STUDENT’S NAME
Permanently Exempt
Type of School
Last
STUDENT IS IN THIS
from Home School
Please print clearly and legible
GRADE LEVEL
Attended
YEAR
Testing Grades 3-9
Give Full Legal Name
Sex
COMPLETED LAST
(Circle one)
Per Home School Test
Date of Birth
STUDENTS IN GRADES
(Circle
SCHOOL YEAR
FIRST
MIDDLE
LAST
Coordinator
3 through 9 MUST TEST
one)
(Circle one)
Month/Day/Year
Place check in box
(Testing - April 2015)
Public Parochial
M
F 0 K 1 2 3 4 5 6 7 8 9 10 11
Private Home
M F 0 K 1 2 3 4 5 6 7 8 9 10 11
Public Parochial
Private Home
Public Parochial
M
F 0 K 1 2 3 4 5 6 7 8 9 10 11
Private Home
Public Parochial
M
F 0 K 1 2 3 4 5 6 7 8 9 10 11
Private Home
Public Parochial
M
F 0 K 1 2 3 4 5 6 7 8 9 10 11
Private Home
Public Parochial
M
F 0 K 1 2 3 4 5 6 7 8 9 10 11
Private Home
Form Revised May 2014
*** PARENTS/LEGAL GUARDIANS MUST FILE UPDATED FORMS EVERY YEAR. ***
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