INTENT TO ESTABLISH AND MAINTAIN A HOME EDUCATION PROGRAM
Parent/Guardian:
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Relationship to student:
Address:
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City:
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State:
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Zip:
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Email
*
Home Phone:
*
Cell Phone:
Child's Information
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Child's Full Legal Name (required)
Date of Birth (required)
Current Grade Level (Optional)
Student ID # (optional)
Student Gender (optional)
1.
Child's Information
Child's Full Legal Name (required)
Date of Birth (required)
Current Grade Level (Optional)
Student ID # (optional)
Student Gender (optional)
2.
Child's Information
Child's Full Legal Name (required)
Date of Birth (required)
Current Grade Level (Optional)
Student ID # (optional)
Student Gender (optional)
3.
Child's Information
Child's Full Legal Name (required)
Date of Birth (required)
Current Grade Level (Optional)
Student ID # (optional)
Student Gender (optional)
4.
Child's Information
Child's Full Legal Name (required)
Date of Birth (required)
Current Grade Level (Optional)
Student ID # (optional)
Student Gender (optional)
5.
Will you be utilizing Florida Virtual School (FLVS)?
*
--Please Select--
Yes
No
By signing my name below, I understand that according to Florida Statute 1002.41, establishing a home education program requires the parent/guardian assume full responsibility for the instruction of their child/children and maintain a portfolio or records and materials. In addition, F.S. 1002.41 requires the parent/guardian preserve the portfolio for 2 years. The parent/guardian shall provide for an annual educational evaluation in which is documented the student’s demonstration of educational progress at a level commensurate with his/her ability and to file a copy of the evaluation annually with the school board in the county in which the student resides. In signing this form, I acknowledge that I have received a copy of F.S. 1002.41 and reviewed it.
Parent/Guardian Signature:
*