<p> AFFIDAVIT OF THE SUPERVISOR OF A HOME EDUCATION PROGRAM</p><p>COMMONWEALTH OF PENNSYLVANIA) ) ss: COUNTY OF______) </p><p>Before me the undersigned notary public, this day personally appeared______</p><p>______, being first duly sworn on oath, deposes and says:</p><p>I attest that I am the parent or guardian or other person having legal custody of (child(ren)’s names and ages)______</p><p>______</p><p>______who reside at (mailing address)______. </p><p>The telephone number at the site is (______)______. </p><p>I attest that the subjects as required by law will be offered in the English language and attached is an outline of proposed education objectives by subject area. According to Section 1327.1, the required outline of proposed education objectives shall not be utilized by the superintendent in determining if the home education program is out of compliance with this section and section 1327.</p><p>I attest that the child(ren) has/have been immunized in accordance with the provisions of section 1303(a) or have a medical exemption or an exemption based upon a strong moral or ethical conviction similar to a religious belief. As stated in section 1327.1(b) of the Public School Code, this affidavit shall be satisfactory evidence of compliance with this provision.</p><p>I attest that the child(ren) has/have received the health and medical services required for students of the child's age or grade level in Article XIV or has/have an exemption based upon a strong moral or ethical conviction similar to a religious belief. As stated in section 1327.1(b) of the Public School Code, this affidavit shall be satisfactory evidence of compliance with this provision.</p><p>I attest that the home education program shall comply with the provision of minimum graduation requirements set forth in Section 1327.1(d) of the Public School Code of 1949 for any students at the secondary level. </p><p>I certify that the supervisor and all adults living in the home and persons having legal custody of a child or children in a home education program have not been convicted of the criminal offenses enumerated in subsection (e) of section 111 within five years immediately preceding the date of this affidavit.</p><p>Sworn to and subscribed before me this ______day of ______, 20____.</p><p>______Notary Public Supervisor of the Home Education Program</p>