Statement of Compliance Form

Statement of Compliance
Home Educator*

First Name Last Name
E-mail*

Confirmation Email
Phone Number*

Area Code Phone Number
Address*

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
Is this a new address?*

YesNo
High School Students report grades here:

http://www.lowcountryhomeschool.com/member-area/report-grades-8th-12th/
School Year*
Student #1*

First Name Last Name
Promoted to or Retained in Grade Level*
Student #2

First Name Last Name
Promoted to or Retained in Grade Level
Student #3

First Name Last Name
Promoted to or Retained in Grade Level
Student #4

First Name Last Name
Promoted to or Retained in Grade Level
Student #5

First Name Last Name
Promoted to or Retained in Grade Level
Student #6

First Name Last Name
Promoted to or Retained in Grade Level
Attendance*

I have fulfilled the required 180 Days of Home Schooling for each student.I will complete the 180 days over the summer. I need to do make up some days. Type in Attendance Plan below.I homeschool ALL-YEAR-ROUND. I have completed the 180 Days. If not, please fill out your Attendance Plan below.
Attendance Plan (List student name, number of days needed, estimated date of completion.)
SAT/ACT TOTAL SCORES & DATE TAKEN:
By clicking submit, I acknowledge the information inputted herein are true. RECORD KEEPING: I understand that it is my responsibility to maintain ALL educational records including transcripts. Educational Records shall include:(1) a plan book, diary, or other record indicating subjects taught and activities in which the student and parent-teacher engage (2) a portfolio of samples of the student’s academic work (3) a semiannual progress report including attendance records and individualized documentation of the student’s academic progress in each of the basic instructional areas specified in the law. ATTENDANCE: I have fulfilled the required 180 days or will do so over the summer as indicated above.*

Acknowledged
Date*

MonthDay Year
Date
Should be Empty: