Download and print the PDF Notice of Intent to Provide Home Instruction (4015).
Notice Of Intent To Provide Home Instruction
School Year: 20____-20____
NAME(S) OF CHILD(REN)
I am eligible to provide home instruction under the following option (check one):
____ I have a high school diploma. (Attach copy of high school diploma OR transcript OR or a higher credential.)
____ I have the qualifications prescribed by the Board of Education for a teacher. (Attach statement to this effect from the Virginia Department of Education.)
____ I have provided a program of study or curriculum delivered through a correspondence course, distance learning program, or in another manner. (Attach proof of program or curriculum such as a receipt or letter of acceptance, or a copy of the table of contents or scope and sequence for an individualized curriculum.)
____ I have attached to this notice evidence that I am able to provide an adequate education for my child(ren). (Attach a statement.)
A description of the curriculum, limited to a list of subjects to be studied inthe coming year, is attached for each child as prescribed in §22.1-254.1 (B) (effective July 2, 2012.)
I understand that by August 1 of next year, I must provide evidence of educational achievement for each child listed above who has reached his sixth birthday on or before September 30 of this school year, as prescribed in §22.1-254.1 (C) of the Code of Virginia.
I hereby certify that I am the parent or guardian of the child(ren) listed above.
Print or type name and address:
SEND THIS FORM TO THE LOCAL SUPERINTENDENT OF PUBLIC SCHOOLS.
Revised effective July 1, 2012