AFFIDAVIT FOR HOME SCHOOL INSTRUCTION
|Student Name||M/F||Birth Date||Designated School||Activities your student may participate in with the principal’s permission|
Parent/Guardian Name: __________________________________ Phone: ________________________
I, ______________________, (Parent/Guardian) of the above named student(s), declare my intent to home school my student(s). I understand and agree:
- To provide instruction in the subjects the Utah State Board of Education requires to be taught in public schools.
- To provide instruction for 180 days and 990 hours each year.
- I am solely responsible for selecting instructional materials and textbooks.
- I am solely responsible for setting the time, place and method of instruction.
- I am solely responsible for testing or otherwise evaluating the home school instruction my student receives.
- If my student is home schooled, he/she may only earn School District credit consistent with School District Policy IKF and Board Rule R277-700.
- This home school instruction affidavit will be ongoing and remain in effect until the student(s) reaches graduation age or unless I notify the school district of plans to re-enroll the student(s) in public school. Any student re-enrolling in a district school must follow procedure outlined in District procedures.
I accept full responsibility for my student and understand that he/she may not qualify for a high school diploma issued by the South Sanpete School District or any of its schools.
(For students with IEPS or identified through child find): My decision to home school does not in any way imply that the school district did not provide a free and appropriate public education and I understand and agree that my student has no individual right to receive some or all of the special education and related services he/she would receive if enrolled in a public school in South Sanpete School District, unless I have arranged for dual enrollment consistent with state law, Section 53A-11-102.5 and the Utah State Board of Education rule, R277-438.
I have read this agreement and understand my obligations as a home school parent.
TO BE SIGNED BEFORE A NOTARY:
Parent/Guardian Signature: _____________________________________ Date:__________________________
Subscribed and sworn to before me this _______ day of ______________________, 20________.
Notary Public: _________________________________________
My Commission Expires: __________________________________
Note: The information on this form is for school/district use only. If schools/districts release home school student information as “directory information.” Schools/school districts must do so consistent with federal law.