Notice of Intent to Provide Home Instruction

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 by § 22.1-254.1 of the Code of Virginia, in lieu of having them attend school.
School Year*
Child's Name*

First NameLast NameAge
Child's Name

First NameLast NameAge
Child's Name

First NameLast NameAge
Child's Name

First NameLast NameAge
Child's Name

First NameLast NameAge
Child's Name

First NameLast NameAge
Child's Name

First NameLast NameAge
Child's Name

First NameLast NameAge
Parent/Guardian Name(s)*

First NameLast Name
Parent/Guardian Name(s)

First NameLast Name
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number*
Please enter a valid phone number.Format: (000) 000-0000.
Email*
example@example.com
I have a high school diploma or a higher credential. (Attach a copy of the diploma OR transcripts AND a list of subjects you will teach below.)I have the qualifications prescribed by the Board of Education for a teacher. (Attach a copy of a teaching license or a statement to this effect from the Virginia Department of Education.)I have provided the child with a program of study or curriculum to be delivered through a correspondence course or a distance learning program or in some other manner. (Attach a notice of acceptance or other evidence of enrollment showing the name and address of the school and a list of subjects to be studied for the coming school year)
Attach required documents for the above option chosen *

Cancelof
As prescribed in § 22.1-254.1 of the Code of Virginia, I have included or will provide the school division with a description of the curriculum, limited to a list of subjects to be studied during the coming school year, and evidence of having met one of the above criteria along with this Notice by August 15 of each year. If I begin home instruction after the school year has started, I will submit this Notice as soon as practicable and comply with the other requirements within 30 days of this Notice to the school division.

I understand that by August 1 following this school year, I must provide evidence of educational achievement as prescribed in § 22.1-254.1 of the Code of Virginia, which defines the requirements for home instruction.
I hereby certify that I am the parent or guardian of the children listed above.*
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