Massachusetts

[PARENT/GUARDIAN FULL NAME] [STREET ADDRESS] [CITY, MA ZIP] [DATE] To the Superintendent of Schools / School Committee, [DISTRICT NAME]: **Home Education Plan — submitted for approval in advance under M.G.L. c. 76, § 1** I request approval in advance to instruct my child at home, as provided in M.G.L. c. 76, § 1 and *Care and Protection of Charles*, 399 Mass. 324 (1987). Student: [STUDENT FULL NAME], age [AGE], grade [GRADE] Parent(s)/guardian(s) providing instruction: [FULL NAME(S)] Home address where instruction will be provided: [ADDRESS] 1. **Proposed curriculum and subjects.** [List each subject to be taught, covering the studies required by law: spelling, reading, writing, English language and grammar, geography, arithmetic, drawing, music, history and Constitution of the United States, duties of citizenship, health education, physical education, and good behavior — plus any additional subjects.] 2. **Length of the school year and hours of instruction.** The home school year will run [START DATE] to [END DATE], comprising at least 180 days of instruction. Hours of instruction in each subject: [SUBJECT — HOURS PER YEAR, repeated per subject]. 3. **Competency of the parents to teach.** [A plain statement of the instructing parent's education and qualifications, e.g. high school diploma / degree held / teaching experience. No certification or degree is required.] 4. **Textbooks and instructional materials.** [For each subject: title/publisher of the textbooks, workbooks, or other instructional aids or lesson plans to be used — provided so the committee can determine the subjects taught and the grade level of instruction.] 5. **Method of periodic evaluation.** I propose to evaluate progress by [standardized testing, in consultation with the district as to test and place / a periodic progress report / dated work samples], as agreed with the district. I ask that the plan be approved in advance of [START DATE], and I am available to explain the plan and answer questions. Signature: ______________________________ [PARENT/GUARDIAN SIGNATURE] Printed name: [PARENT/GUARDIAN FULL NAME] · Telephone: [PHONE]