Statement of Intent to Educate Through a Home-Based Educational Program 2018-2019
2018-2019 Academic School Year
Valid from June 1, 2018 - June 1, 2019

A copy of this form will be sent to the Home-Based Education department of Jeffco Public Schools. That department will process it fourteen days after it's receipt.

One form per child please.

Email address *
Student First Name *
Your answer
Student Middle Initial *
If the child does not legally have a middle name, please type "n/a" or "no middle name"
Your answer
Student Last Name *
Your answer
Student's date of Birth *
MM
/
DD
/
YYYY
Student's gender
Student's Grade *
Home Address *
Street Address, City, State, Zip code
Your answer
Planned Number of hours of instruction hours per day (avg.) *
Home school programs must have no less than 172 days of instruction, averaging 4 contact hours per day. - CO Department of Edu
Your answer
Days per school Year *
Home school programs must have no less than 172 days of instruction, averaging 4 contact hours per day. - CO Department of Edu
Your answer
Parent's Name *
First & Last please
Your answer
Home School Enrollment History *
If a Renewal Notification, if you haven't already done so, please submit most current odd year testing result for this student to HSC (we will forward) or Jeffco Home Based Education dept
Optional Information
The following information is optional; however it does assist us in keeping accurate information for your student.
Your child's Registration Code or Student ID from Jeffco Connect
This step is optional. Please visit https://jeffcoconnect.jeffco.k12.co.us/ and set up an account for your family. Any information left blank will have to be completed by a Jeffco employee taking an educated guess. The Registration code can be found by click on your child's name, this will open the summary page, right above their name. If your child has been enrolled in Jeffco Schools before, they will already have a Student ID. You can enter either one.
Your answer
Home Telephone Number
Your answer
Ethnic Information
“If a student’s home school has requested a case be filed with or is current in the 1st Judicial Court because of habitual truancy, the Jefferson County Public Schools Truancy Office must approve the intended curriculum and aspects of the homeschooling process to be used by the family.” *
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