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.Format: (000) 000-0000.
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
Please upload your diploma (or equivalent), or submit one by email to sbuchana@k12.wv.us

Cancelof
Signature
Date

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