Nebraska

*This letter is the filled-companion to NDE's exempt school forms (Form A — Statement of Election and Assurances, completed by one parent, legal guardian, or educational decisionmaker per student; Form B — Authorized Parent Representative Form). File through NDE's online system or by mail to the Exempt School Program Office; this letter carries the statutory contents of § 79-1601 and Rule 13.* --- STATEMENT OF ELECTION AND ASSURANCES — EXEMPT SCHOOL Neb. Rev. Stat. § 79-1601 · NDE Rule 13 (92 Neb. Admin. Code ch. 13) To: Commissioner of Education, Nebraska Department of Education, Exempt School Program Office Name of the exempt school: [SCHOOL NAME — e.g. "Smith Home School"] Parent Representative (the person responsible for filing the exempt school paperwork): [NAME, ADDRESS, TELEPHONE, EMAIL] Student(s) enrolled: [CHILD'S NAME, DATE OF BIRTH — repeat per child] *(A certified copy of each student's birth certificate accompanies the first enrollment, per § 43-2007.)* Dates of operation for the [SCHOOL YEAR] school year: [START DATE] through [END DATE], providing at least 1,032 hours of instruction (elementary grades) / 1,080 hours (secondary grades). Election: I elect for my child to attend a school that does not meet state approval or accreditation requirements, because those requirements [CHECK ONE]: [ ] violate my sincerely held religious beliefs; or [ ] interfere with my decisions in directing my child's education. Assurances: The exempt school will provide a program of instruction leading to the basic skills in language arts, mathematics, science, social studies and health. The authorized Parent Representative will annually submit to the Commissioner of Education the information required by § 79-1601 and Rule 13. I verify that the instructional monitor(s) are qualified to monitor instruction in those basic skills. The information provided is true and accurate. Signature of parent / legal guardian / educational decisionmaker (one per student): ______________________________ Date: ______________ ## Conditional Affidavit A — Delayed Entry for a Six-Year-Old (§ 79-201) *Conditional — used only when a child will reach age six prior to January 1 of the school year but will not reach age seven prior to January 1, and the parent delays the child's entry. Under § 79-201(3)(d)–(e), compulsory attendance does not apply to such a child when the parent or guardian has signed this affidavit and filed it with the school district in which the child resides. NDE does not provide or collect this form (NDE Exempt School FAQ B2) — the resident district does. Text prepared from Neb. Rev. Stat. § 79-201(3)(d)–(e).* --- AFFIDAVIT OF DELAYED ENTRY — CHILD AGE SIX Neb. Rev. Stat. § 79-201(3)(d)–(e) To: [NAME OF RESIDENT PUBLIC SCHOOL DISTRICT], the school district in which the child resides STATE OF NEBRASKA ) ) ss. County of [COUNTY] ) The undersigned, being first duly sworn, states upon oath as follows: I am the parent or guardian of [CHILD'S FULL NAME]. The child's date of birth is [DATE OF BIRTH]. The child will reach six years of age prior to January 1 of the [SCHOOL YEAR] school year, but will not reach seven years of age prior to January 1 of such school year. I elect not to enroll the child in school for this school year, and I affirm (check one): [ ] (§ 79-201(3)(d)) The child is participating in an education program that I believe will prepare the child to enter grade one for the following school year; or [ ] (§ 79-201(3)(e)) I intend for the child to participate in a school which has elected or will elect pursuant to section 79-1601 not to meet accreditation or approval requirements, and I intend to provide the Commissioner of Education with a statement pursuant to subsection (3) of section 79-1601 on or before the child's seventh birthday. Signature of parent or guardian: ______________________________ Printed name: [NAME] · Address: [ADDRESS] · Telephone: [TELEPHONE] Date: ______________ Subscribed and sworn to before me this ______ day of ______________, 20______. ______________________________ Notary Public — State of Nebraska [SEAL] · My commission expires: ______________ ## Conditional Affidavit B — Inability to Produce a Birth Certificate (§ 43-2007) *Conditional — used only on a student's first enrollment in the exempt school, and only when a certified copy of the student's birth certificate cannot be produced. Under § 43-2007(3), the parent or guardian of a student receiving his or her education in an exempt school provides the Commissioner of Education either (a) a certified copy of the student's birth certificate or (b) other reliable proof of the student's identity and age accompanied by an affidavit explaining the inability to produce a copy of the birth certificate. This affidavit accompanies that other reliable proof; it does not replace it. Text prepared from Neb. Rev. Stat. § 43-2007(3).* --- AFFIDAVIT EXPLAINING INABILITY TO PRODUCE A BIRTH CERTIFICATE Neb. Rev. Stat. § 43-2007(3) · Missing Children Identification Act To: Commissioner of Education, Nebraska Department of Education, Exempt School Program Office *(Accompanies the exempt school's first-enrollment filing; attach the other reliable proof identified below.)* STATE OF NEBRASKA ) ) ss. County of [COUNTY] ) The undersigned, being first duly sworn, states upon oath as follows: I am the parent or guardian of [STUDENT'S FULL NAME], born [DATE OF BIRTH] at [PLACE OF BIRTH], who is enrolled in [NAME OF EXEMPT SCHOOL], an exempt school under sections 79-1601 to 79-1607. I am unable to produce a certified copy of the student's birth certificate because: [EXPLANATION OF THE INABILITY — e.g. no birth certificate was issued / the certificate is not available from the state or country of birth / the record cannot be obtained despite diligent effort] In place of the birth certificate, I provide the following other reliable proof of the student's identity and age, attached to this affidavit: [DESCRIPTION OF THE PROOF PROVIDED — e.g. passport, hospital record, baptismal record, prior school record] The information stated in this affidavit is true and correct to the best of my knowledge. Signature of parent or guardian: ______________________________ Printed name: [NAME] · Address: [ADDRESS] · Telephone: [TELEPHONE] Date: ______________ Subscribed and sworn to before me this ______ day of ______________, 20______. ______________________________ Notary Public — State of Nebraska [SEAL] · My commission expires: ______________