Notice of Intent to Homeschool

NOTICE OF INTENT TO HOMESCHOOL

We the undersigned parents and/or guardians do hereby serve notice to the superintendent of School District – XXXX Public Schools that we have established and are in charge and control of a non-public home-based educational program pursuant to CRS 22-33-104.5 for the 2012-2013 school year, beginning Month XX, 2012. (School Year) (Date)

Child’s Name Child’s Age Attendance 4hrs/day, 172 days/yr 4hrs/day, 172 days/yr 4hrs/day, 172 days/yr

All children listed above currently reside at: (Street Address Goes here)

The test or evaluation results of our children will be submitted to: XXX Public School District when they are tested or evaluated upon completion of grades three, five, seven, nine, and eleven.

Signatures:

______Date: ______