<p> NOTICE OF INTENT TO HOMESCHOOL</p><p>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)</p><p>Child’s Name Child’s Age Attendance 4hrs/day, 172 days/yr 4hrs/day, 172 days/yr 4hrs/day, 172 days/yr</p><p>All children listed above currently reside at: (Street Address Goes here)</p><p>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.</p><p>Signatures:</p><p>______Date: ______</p><p>______Date: ______</p>
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