Notice of Intent to Homeschool

Notice of Intent to Homeschool
Date you wish to initiate homeschooling*

MonthDayYear
Date
Student Name*

First NameLast Name
Date of Birth*

MonthDayYear
Date
Current Grade*
Parent/Guardian Name*

First NameLast Name
Parent/Guardian Email*
example@example.com
Parent/Guardian Phone Number*
Please enter a valid phone number.
Parent/Guardian Address*

Street Address

CityState / Province

Postal / Zip Code
Mailing Address (if different)

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
The person providing home instruction shall submit evidence of a high school diploma or equivalent*

A copy of my diploma or equivalent is included with this NOIA copy of my diploma or equivalent is on file with the homeschool office
Please upload your diploma (or equivalent), or submit one by email to sbuchana@k12.wv.us

Cancelof
Signature*

Clear
Date

MonthDayYear
Date
**Hope Scholarship recipients must submit a Hope Scholarship notice of intent. Do not use this form.**
Should be Empty: