[City of Bristol CT] HomeSchoolForm

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Notice of Intent

Instruction of Student at Home

Phone Number

Parent Email

District School

Grade

Name of Home Schooling Teacher

Phone Number of Homeschooling Teacher

Will student receive instruction in READING?

Will student receive instruction in WRITING?

Will student receive instruction in SPELLING?

Will student receive instruction in ENGLISH GRAMMAR?

Will student receive instruction in GEOGRAPHY?

Will student receive instruction in ARITHMETIC?

Will student receive instruction in U. S. HISTORY CITIZENSHIP (including a study of Town, State and Federal Governments)?

Will student receive instruction in PHYSICAL EDUCATION (recommended)?

Will student receive instruction in SCIENCE (recommended)?

Total number of days scheduled for instruction:

Teacher's method of assessment of student progress:

Parent's Email Address

I ACKNOWLEDGE AND ACCEPT FULL RESPONSIBILITY FOR THE EDUCATION OF MY CHILD IN ACCORDANCE WITH THE REQUIREMENTS OF STATE LAW.

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First Name

Last Name

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I agree to electronically sign and to create a legally binding contract between the other party and myself, or the entity I am authorized to represent.

Parent's picture identification (examples below)

current driver's license
current State of CT issued ID
current passport
current Permanent Resident Alien Card

Upload ONE Parent / Guardian's ID from list above

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FOR DISTRICT USE ONLY

_____________________________________________________________________________________________________________

Superintendent's Approval

_________________________________________________ Date

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Notice of Intent

Instruction of Student at Home

Full Name of Student

Student's Date of Birth

Address

Parent / Guardian's Full Name

First Date of Homeschooling

Address of Homeschooling Teacher

Today's Date

Sign Here

Upload ONE Parent / Guardian's ID from list above