NOTICE OF INTENT TO PROVIDE HOME INSTRUCTION
I am providing notice of my intention to provide home instruction for the child(ren) listed below in lieu of having them attend school as provided in §22.1-254.1 of the Code of Virginia (1950) as amended.
School Year: 20____-20____
NAME(S) OF CHILD(REN) AGE(S)
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, associate’s degree,
baccalaureate degree or higher.)
____ 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 enrolled the child(ren) in a correspondence course approved by the Board of Education. (Attach
notice of acceptance or receipt for tuition showing name and address of school and the courses in
which each child is enrolled.)
____ I have attached to this notice a program of study for the coming year which includes the Virginia
Standards of Learning Objectives for language arts and mathematics OR a statement describing why I
am able to provide an adequate education for my child(ren).
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 of the Code of Virginia, which defines the requirements for home instruction.
____ I would like a copy of §22.1-254.1 on home instruction.
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