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DECLARATION OF INTENT TO HOME SCHOOL
By completing this form you declare you are the parent/guardian/legal custodian of the child(ren) listed below, and that said child(ren) is (are) between the ages of eight and eighteen and as such are subject to requirements found in Chapter 28A.225 RCW, Compulsory Attendance. You also declare your intent to provide said child(ren) home-based instruction as specified in RCW 28A.225.010(4). In accordance with RCW 28A.225.010, the Declaration of Intent to Home School must be filed annually by September 15 or within two weeks of the beginning of any public school quarter, trimester, or semester with the Superintendent of the public school district within which the parent resides.
School Year
Parent/Guardian Information
Parent/Guardian Last Name
Your answer
Parent/Guardian First Name
Your answer
Phone Number (optional)
Your answer
Street Address (Number and Street Name)
Your answer
Zip Code
Your answer
The home-based instruction will be supervised by a person certificated in Washington State pursuant to RCW 28A.410.
Student Information
Below you will enter information regarding the child who will be receiving home-based instruction. You will need to submit a separate form for each child receiving home-based instruction.

Please note, the Washington Graduation Year is established the year a student is identified as a 9th grader. Grade level cannot be changed after the Washington Graduation Year has been set.

Child's Last Name
Your answer
Child's First Name
Your answer
Child's Age
Your answer
Child's Grade Level
Child's Resident School
At what school would your child be a student based on your physical address?
Elementary Schools (choose one if applicable)
Middle Schools (choose one if applicable)
High Schools (choose one if applicable)
Electronic Signature
In providing your electronic signature below, you verify that all information contained in this deceleration to be accurate and in accordance with RCW 28A.225.
Full Name of Parent/Legal Guardian
Your answer
Today's Date
MM
/
DD
/
YYYY
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