Notice Of Intent To Home School Template (Page 3 of 4) in pdf

Notice Of Intent To Home School Template Page 3

Page Must Be Completed - Curriculum (Required information:

DISTRICT

OFFICE, do not accept this form if this section is blank.)

Give a brief description of the basic core curriculum to be used and include a list of the subjects to be taught:

Class Schedule (Required information:

DISTRICT OFFICE,

do not accept this form if this section is blank.)

Describe the schedule planned for your home school: (Include the hours per day, days per week, number of weeks)

Educational Qualifications of Parent/Teacher(s)

(Circle the highest level of educational attainment.)

Print or Type Name of Parent/ Guardian

Parent/Guardian

School

College

Degree

(Circle one)

(BA, etc.)

Name & Address of Institution

Parent

Guardian

H.S.

Col.

6 7 8 9 10 11 12 Grad.

1 2 3 4 Grad.

Parent

Guardian

H.S.

Col.

6 7 8 9 10 11 12 Grad.

1 2 3 4 Grad.

No approval letter or curriculum will be sent to parents/guardians. Parents have FULL responsibility for providing material(s) to their

children.

DRIVER’S PERMIT/LICENSE SECTION ONLY –

No need to complete below this line if you are not seeking a driver’s license.

This section below ONLY APPLIES FOR STUDENTS 14 YEARS OF AGE OR OLDER who are obtaining

a driver’s permit or license during the 2014-2015 year.

Arkansas Department of Education Rules and Regulations Governing Home Schools 10.00 States: “A student enrolled in a home school shall present proof of home schooling in

the form of a notarized copy of the Notice of Intent to Home School. The parent/guardian has the responsibility of providing the notarized copy.”

Please call the Home School Office at 501-682-1874 if you have questions. Make a copy of this form and have the COPY notarized and a birth certificate when seeking a driver’s permit or

licenses.

Notary Seal:

______________________________________________________

Signature of Notary

Date

Parent Signature

Date

Arkansas Code Annotated § 6-15-501 through § 6-15-508

Form Revised May 2014

Please retain a copy of the completed form for your files.