Notice of Intent

NOTICE OF INTENT TO PROVIDE HOME INSTRUCTION

I am providing notice of my intention to provide home instruction for the children listed below as provided for by Section 22.1-254.1 of the Code of Virginia (1950) as amended, in lieu of having them attend school.

School year: 20____ - 20____

NAME(S) OF CHILD(REN)	DATE OF BIRTH	GRADE LEVEL
___________________________________________	________________	__________
___________________________________________	________________	__________
___________________________________________	________________	__________

I wish to be recognized as eligible to provide home instruction by selecting the option indicated below. (Check one)

I have a baccalaureate degree. (Attach a copy of diploma or certificate from college.)

I have the qualification prescribed by the Board of Education for a teacher. (Attach copy of teaching certificate or statement to this effect from the Virginia Department of Education.

I have enrolled the child(ren) in a correspondence course approved by the Board of Education. (Attach notice of acceptance or other evidence of enrollment showing name and address of school and the courses in which each child is enrolled.)

I have attached to this notice a program of study for the coming year which includes the state Standards of Learning objectives for language arts and mathematics for each child. Also, I have attached a statement which states why I am able to provide an adequate education for my child or children.

I understand that by August 1 of next year, I must provide evidence of educational achievement as prescribed in Section 22.1- 254.1 of the code of Virginia which defines the requirements for home instruction.

Check if desired:

I would like a copy of Section 22.1-254.1 of the Code.

I hereby certify that I am the parent or guardian of the child or children listed above.

Signature_________________________________________________________Date________________________

Social Security No. _____________________________________________________

Print or type name and address:

________________________________________________________________________________________