Notification of Termination of Home Education Program
THE SCHOOL BOARD OF BROWARD COUNTY, FLORIDA
Notification of Termination of Home Education Program
Use of this form is optional. It is provided for the parent's/guardian's convenience.
Please complete one for each student.
In compliance with section 1002.41 (1)(a), Florida Statutes this is written notice from the parent/guardian to terminate the home education program for the following student. The parent/guardian is responsible for keeping the home education student's complete portfolio and learning log for two full years. Children between the ages o f 6 and 16 years are subject to compulsory school attendance per sections 1003.21, 1003.24, Florida Statutes. For additional information r e f e r t o t h e w e b s i t e .
Please Print:
STUDENT NAME
DATE OF BIRTH
Name of Parent(s)/ Guardian(s) _______________________________________________ Home
Address _______________________________________ Apt # _____________________ City
________________________________________ State ___________ Zip Code _________
Telephone (
)_________________________
The reason for termination is:
Entry to ___________ public or ___________ private school
School Name ______________________________________________________ ______________ Moving out of Broward County ______________ Completion of High School (e.g., correspondence program) ______________ Taking the GED (General Education Diploma) Test Other (specify) _________________________________________________________
Signature of Parent/Guardian _______________________ Date _______________________
Address:
The School Board of Broward County
Home Education Office
Lauderdale Manors Early Learning & Family Resource Center
1400 NW 14th Court
Fort Lauderdale, FL 33311
Website:
Email:
Home.education@
Phone:
(754) 321-1558
Fax:
(754) 321-1694
Form#4723B REV 10/17
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