Notice of Intent to Provide Home Instruction Form

This form is required as an official notice of your intent to provide home instruction in lieu of having one or more children attend public school. Enter the Loudoun County address where you will reside during the school year you specify below. If you are building a home or buying a home please enter your expected address. Example: If your address is 12345 First Street, Leesburg VA 20176, you should enter 12345 in the first box and 20176 in the second box.
*Required fields
School Year: 2019-2020
Request Type: 
Student Information
Birth Date:
Grade:
Address:
Mailing Address if different from the address above: 
Parent Information
Parent Salutation:
*Required fields
I wish to be recognized as eligible to provide home instruction by selecting the option indicated below.(Check one of the following)
    Requirements:
  • Parents must submit documentation. Can submit high school diploma, transcript or college degree.
  • Parents must submit a description of the curriculum.
    Requirements:
  • Parents must submit copy of teaching certificate or statement to this effect from the VA Dept. of Education.
  • Parents must submit a description of the curriculum.
    Requirements:
  • Provide proof of enrollment in a correspondence course or distance learning program. Proof of enrollment may be an acceptance letter from the correspondence school or a copy of a paid receipt.
  • Parent must submit program of study or curriculum.
    Requirements:
  • Parents must submit a statement as to why they are able to provide an adequate education for the child.
  • Parent must submit a description of the curriculum.
*Required fields:
Part Time Enrollment only applies for 7th to 12th grade, please click next!
Your request is now complete and summarized below. If you agree with the information entered below, please check the "I Understand" and "I Certify" checkboxes below and click on the Submit button.
School Year: 2019-2020
Student First Name:
Student Last Name:
Birth Date: -
Student Grade:
Address:
Mailing Address If Different:
Mailing Address Line 1:
Mailing Address Line 2:
City:
State:
Zipcode:
Request Type:
Parent First Name:
Parent Last Name:
Parent Email:
Home Phone:
Work/Cell Phone:
You have selected:

1. Parents must submit documentation with a high school diploma, transcript, or college degree. At the bottom of this page, you may attach the documentation to your Notice of Intent. You will be given an email address and fax number upon completion of the Notice of Intent, which you may use to provide us with this information if you prefer.

2. Parents must submit a description of the curriculum. You may enter up to 5,000 characters in the following text box OR attach supporting documentation in the space provided below. At the end of this form, you will be given an email address and fax number which you may use to provide us with this information as well.

You have selected:

1. Parents must submit a copy of teaching certificate or statement to this effect from the VA Dept. of Education. At the end of this form you will be given an email address and fax number which you may use to provide us with this information.

2. Parents must submit a description of the curriculum. You may enter up to 5,000 characters in the following text box OR attach supporting documentation in the space provided below. At the end of this form, you will be given an email address and fax number which you may use to provide us with this information as well.

You have selected:

1. Provide proof of enrollment in a correspondence course or distance learning program. Proof of enrollment may be an acceptance letter from the correspondence school or a copy of a paid receipt.

2. Parents must submit a description of the curriculum. You may enter up to 5,000 characters in the following text box OR attach supporting documentation in the space provided below. At the end of this form, you will be given an email address and fax number which you may use to provide us with this information as well.

You have selected:

1. Parents must submit a statement as to why they are able to provide an adequate education for the child.

2. Parents must submit a description of the curriculum. You may enter up to 5,000 characters in the following text box OR attach supporting documentation in the space provided below. At the end of this form, you will be given an email address and fax number which you may use to provide us with this information as well.

Note: You must check all the check boxes below to complete the registration.

*Required fields