<p> Lake County School Board</p><p>HOME EDUCATION WRITTEN EVALUATION FORM</p><p>There are five options for fulfilling the requirement for an annual educational evaluation. Selecting a teacher holding a valid regular Florida certificate to review and discuss the contents of the required portfolio with the student is an option that is used frequently. (The specific form below is not required but is provided by LCSB for your convenience. If you have more than one child, please make a copy for each child.) STUDENT INFORMATION: (Please Print) ______(Student Name) ______(Date of Birth) (Evaluation Date) ______(Student Address) (Grade Level of this Evaluation)</p><p>______(City, State, Zip Code)</p><p>______(_____)______(Name of Parent/Guardian) (Phone Number)</p><p>STATEMENT FROM FLORIDA CERTIFIED TEACHER:</p><p>Upon review of the portfolio and discussion with the student named above, I certify that the student has demonstrated progress at a level commensurate with his/her ability and should be promoted to the next grade level. I understand Florida law requires that I hold a valid regular Florida certificate in elementary education or in an academic subject at the secondary level. My signature attests of my qualification and I have attached a copy of my certificate.</p><p>______(Signature of Teacher/Evaluator) (Certificate Number)</p><p>______(Print Name Of Teacher/Evaluator) (Certificate Expiration Date)</p><p>It is assumed that you will continue to home educate your child(ren) unless you submit a written notice of termination.</p><p>Mail to: Lake County School Board Student Services Office 512 S. Palm Ave. Howey-in-the-Hills, FL 34737 Revised 5/2004 </p>