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LBC-E, Notice of Intent to Pursue a Program of Home Education

Date Received: _____________________

 

GARDNER PUBLIC SCHOOLS

 

Notice of Intent to Pursue a Program of Home Education

Academic Year ________

 

 

Instructions: Please complete this form, attach any additional information and forward it to the Superintendent of Schools, 70 Waterford Street, Gardner, MA  01440 prior to the starting date of the home education program.  Expect a prompt response to this from the Superintendent or designee.  If this process is initiated during the school year, the student must remain in school until the school district and the parents agree jointly to the home education plan.

 

A.            Parent Name ______________________________________________

 

Address __________________________________________________

 

                Phone (daytime) __________________ (evening) _________________

 

                Student(s) _______________________ Birthdate _________________            Grade Level ___________

 

                                     _______________________              _________________                               ______________

 

                                     _______________________              _________________                               ______________

 

                                     _______________________              _________________                               ______________

 

                                     _______________________              _________________                               ______________

 

B.            On a separate sheet, describe the instructional program to be taught, including subjects, texts and instructional aides to be used.

 

C.            Name(s) and academic background, life experience and/or qualifications of those who will be instructing the child(ren), as they relate to the instructional program described in section B.

 

 

D.            Check the method of assessment to be used followed by a brief description.

 

  Daily logs, journals, progress reports, portfolios or dated work samples

 

 

 

 

  An independent report made by someone acceptable to both Superintendent and parent(s) or guardian(s)

 

 

 

 

  Standardized test results

 

 

 

 

  Consultation with the Superintendent or appropriate school principal

 

 

 

 

  Any other method agreed to by both Superintendent and home educator(s)

 

 

 

 

E.            A sample daily schedule.

 

 

The following signature confirms the intent to provide a minimum of 900 hours (elementary) 990 hours (secondary) 180 days of instruction.

 

 

________________________________________                   _______________________

Signature of Parent or Guardian                                                       Date Submitted

 

The signature of the school official indicates final approval of this plan.  A parent/administrative conference may be scheduled.

 

 

_______________________________________                     _______________________

Signature of Superintendent or Designee                                        Date of Response

Attached to this application is a packet that includes the following materials:

 

  • Gardner Public Schools Home Education Policy

 

 

Failure of a home educator to abide in good faith by the procedures outlined above may result in the School Committee taking action under Massachusetts General Law Chapter 76, sections 2 and/or 4, upon the recommendation of the Superintendent.  Child Requiring Assistance (CRA)proceedings pursuant to Massachusetts General Law Chapter 119, section39E, will not be invoked for any child pursuing a home education program.

 

Legal Ref: M.G.L. Chapter 76, Sections 1, 2, and 4

                  Charles Decision

 

 

[Reviewed: September 2003]

 

[Revised: November 2016]

 

 

 

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