Virginia

[PARENT NAME] [STREET ADDRESS, CITY, VA ZIP] [PHONE] · [EMAIL] [DATE] Division Superintendent, [NAME OF SCHOOL DIVISION] Re: Annual notice of intent to provide home instruction — Va. Code § 22.1-254.1 Dear Division Superintendent: I notify you that I intend to provide home instruction in lieu of school attendance for my child(ren) during the [SCHOOL YEAR] school year, under Va. Code § 22.1-254.1: Child(ren): [FULL NAME(S) OF CHILD(REN)] I meet the following criterion of § 22.1-254.1A (check one; evidence attached as indicated): [ ] (i) I hold a high school diploma. (Evidence attached.) [ ] (ii) I am a teacher of qualifications prescribed by the Board. (Evidence attached.) [ ] (iii) I provide my child with a program of study or curriculum, which may be delivered through a correspondence course or distance learning program or in any other manner. (Evidence attached.) [ ] (iv) I provide evidence that I am able to provide an adequate education for my child. (Evidence attached.) Description of the curriculum, limited to a list of subjects to be studied during the coming year, as § 22.1-254.1B provides: [LIST OF SUBJECTS, PER CHILD IF DIFFERENT] I understand that by August 1 following this school year I will provide evidence of progress as § 22.1-254.1C requires. Signature: ______________________________ Date: ____________ [PARENT NAME, printed]