AFFIDAVIT OF INTENT TO HOMESCHOOL
Send the notarized original document to your County School Superintendent. Keep a copy for your records.
A.R.S. §15-802 defines a homeschool as “a non-public school conducted primarily by the parent or guardian, or non-public instruction provided in the child’s home.”
Please do not file an Affidavit of Intent to Homeschool for your child if he/she is enrolled in a virtual charter school/public-school-at-home program or has an Empowerment Scholarship Account (ESA) contract with the State of Arizona.
STUDENT INFORMATION
Last Name: |
_______________________________ First Name: _______________________________ Middle Name: _____________________ |
Date of Birth: |
_________________________________ (Proof of birth is required according to A.R.S. §15-828. See below) |
Address: |
______________________________________________________________________________________________________________ |
City: |
__________________________________________________________________, AZ |
Zip Code: __________________________ |
Phone: |
_________________________________________________ |
|
PARENT/GUARDIAN INFORMATION |
|
Last Name: |
__________________________________ First Name: ________________________________ Middle Name: ____________________ |
Last Name: |
__________________________________ First Name: ________________________________ Middle Name: ____________________ |
□My child is not yet eight years of age and I elect not to begin formal education at this time.
PROOF OF BIRTH
Please include a certified copy (not a photocopy) of your child’s birth certificate or other acceptable proof of birth as outlined in Arizona Revised Statutes §15-828.
PRIVACY NOTICE
The undersigned expressly prohibits the release of any and all information contained in this form including directory information as defined in 20 U.S.C. §1232g (a)(5)(A), without prior written consent by the undersigned. See 20 U.S.C. §1232g (a)(5)(B) and ARS §15-141.
Under penalty of law, I attest the information provided on this form is true to the best of my knowledge.
PARENT/GUARDIAN SIGNATURE ____________________________________________________________
Subscribed and sworn before me this __________ day of _______________________________, 20_________
NOTARY SEAL
by _________________________________________________ Commission expires: ___________________
NOTARY PUBLIC
Arizona Families for Home Education | www.afhe.org
