Intent to Homeschool Form

To: Parent/Guardian of Homeschooled Student

From: Amanda Caldwell, Assistant Superintendent of Schools

Re: District Notification of Intent to Homeschool

This form is to be completed if you intend to homeschool your child/children. It is required to be completed annually and submitted by July 1 of the year you will be homeschooling or within 14 days of the beginning of your homeschool program. Once this Notice of Intent is received, you will be provided additional information about required documentation from our Homeschool Coordinator.
Todays Date*

MonthDayYear
Date
Parent Name*

First NameLast Name
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Cell Phone #*
EMail Address*
example@example.com
Home Phone #

Area CodePhone Number
List student who will be homeschooled: (Please submit one form for each student)
Student Name*

First NameLast Name
DOB*

MonthDayYear
Date
Student Grade*
School Year*
Please submit this form by July 1. Once received you will be emailed an IHIP form to be completed. The IHIP form must be completed and approved prior the start of school.
Parent Signature Signature Date
Should be Empty: