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Homeschooling Form

Declaration of Intent to Provide Home-Based Instruction

Please read the Commonwealth's guidance and policies regarding homeschooling

Until your request has been received and approved, your student MUST remain in school

Student's Name*

Answer Required

Student's Grade *

As of September of the current year

Answer Required

Student's Age*

Answer Required

Name of School Student Is/Would Attend*

Answer Required

Parent(s)/Guardian(s) Name(s)*

Answer Required

Parent(s)/Guardian(s) Address*

Answer Required

Parent(s)/Guardian(s) Phone Number*

Please provide the best number to reach you

Answer Required

Parent(s)/Guardian(s) Email Address*

Answer Required

Name of Person Providing Instruction*

Answer Required

Qualifications of the Person Providing Instruction

Answer Required

Subject Areas to be Covered*

Answer Required

Curriculum to be Utilized*

Please provide as much information as possible, including names of textbooks and lesson plans

Answer Required

If you want to share any of the materials you will be utilizing, please upload them here:

Answer Required

Choose a file or drag it here.

Number of Days and Hours of Instruction*

Answer Required

Method of Evaluating Progress*

Answer Required

By checking this box, I acknowledge that I have read, understand, and agree to the policies and procedures related to homeschooling as detailed by the Commonwealth of Massachusetts*

Answer Required

Yes

I DECLARE (OR CERTIFY, VERIFY, OR STATE) UNDER PENALTY OF PERJURY UNDER THE LAWS OF THE UNITED STATES OF AMERICA, THAT THE INFORMATION PROVIDED ON THIS FORM IS TRUE AND CORRECT*

Answer Required

Yes, the Information Provided on this Form is Accurate

Today's Date*

Answer Required