Pullman School District Form 3114F

A parent who intends to cause his/her child(ren) to receive home-based instruction in lieu of attendance or enrollment in a public school, approved private school, or an extension prograin of an approved private school must file an annual declaration of intent to do so in the format prescribed below: I do hereby declare that I am the parent, guardian, or legal custodian of the child(ren) listed below; that said child(ren) is (are) between the ages of 8 and 18 and as such are subject to the requirements found in RCW Chapter 28A.225 Compulsory Attendance; I intend to cause said child(ren) to receive home-based instruction as specified in RCW 28A.225.010(4); and if a certificated person will be supervising the instruction, I have indicated this by checking the appropriate space below.

By signing this document, I acknowledge that the child(ren) listed above is (are) not intending to earn a high school diploma under the guidelines of District Policy at this time.

By electronically signing this document you agree your electronic signature is the legal equivalent of your manual signature on this form. Note: This statement must be filed annually by September 15 or within two weeks of the beginning of any public school quarter, trimester, or semester with the superintendent of the Pullman School District.