Vermont

*Filled-companion to the Agency of Education's official Home Study Enrollment — Notice of Intent form, which is the filing itself.* To the Secretary of Education, Agency of Education, Home Study Office: **Notice of Intent to Enroll in a Home Study Program** — 16 V.S.A. § 166b(a) Student: [STUDENT FULL NAME] Age: [AGE] · Date of birth: [MONTH / DAY / YEAR OF BIRTH] Parent(s)/guardian(s) with legal custody authorized to make educational decisions: 1. [FULL NAME] — [MAILING ADDRESS] — [EMAIL] — Town of legal residence: [TOWN] — Telephone: [PHONE] 2. [FULL NAME, IF ANY] — [MAILING ADDRESS] — [EMAIL] — Town of legal residence: [TOWN] — Telephone: [PHONE] Attestation — assessment. I attest that the academic progress of the child enrolled in this home study program will be assessed at the end of each school year, and that I will maintain the record of such assessments. The assessment will be by a permitted means under § 166b(a)(3): [a standardized assessment / a review of the student's progress by an individual who holds a current Vermont teacher's certificate / a parent or guardian report and portfolio including a summary of what the student learned and at least four samples of student work / grades from an online academy or school / evidence of passing of the GED]. Attestation — instruction. I attest that the child will be provided the equivalent of at least 175 days of instruction in the minimum course of study per year: [for a child younger than 13 — the subject areas listed in 16 V.S.A. § 906 / for a child 13 or older — the subject areas listed in § 906(b)(1), (2), (4) and (5) / for a student with a documented disability — with adaptations to support the student in the home study program]. [First enrollment only, for a child not previously enrolled in a Vermont public school or Vermont home study program: independent professional evidence regarding whether the child has a documented disability, and how it may affect the student's educational progress in a home study program, is attached.] Signatures of all parents/guardians with legal custody authorized to make educational decisions: ______________________________ [NAME] Date: [DATE] ______________________________ [NAME, IF ANY] Date: [DATE] [Or: I attest that I hold sole primary educational decision-making authority for this student.]