Notice of Intent to Establish and Maintain a Home ...
Notice of Intent
to
Establish and Maintain a Home Education Program
Date: _______________________________________
To the Superintendent of ________________________________________ School District
This is to inform you that effective _______________________________, a home education program
date
meeting the requirements of ss. 1002.41 has been/will be established for my children as listed below.
Child¡¯s Name: _____________________________________________ Date of Birth: ______________
Child¡¯s Name: _____________________________________________ Date of Birth: ______________
Child¡¯s Name: _____________________________________________ Date of Birth: ______________
Child¡¯s Name: _____________________________________________ Date of Birth: ______________
These children reside at:
Street ____________________________________________________________________________
City: ________________________________________________, FL
Zip: ____________________
Sincerely,
__________________________________________________
Parent/Guardian signature
___________________________________________________
Printed name
Keep a copy for your records
Mail (return receipt requested) to your school district within 30 days of establishing your program.
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