Home School Application

Instructions: Please complete this form, attach any additional information and forward it to the Wakefield School Department, Office of the Superintendent, Attn: Linda Muldowney, 60 Farm Street, Wakefield, MA 01880 or email linda.muldowney@wpsk12.org prior to the start of the home education program. 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.

PARENT INFORMATION

First Name *

Last Name *

Street Address *

Address Line 2

City *

State *

Zip Code *

Phone Number *

Email Address *

Student Name *

Birthdate * +

Grade Entering *

Student Name

Birthdate +

Grade Entering

Student Name

Birthdate +

Grade Entering

A, Describe the instructional program to be taught, including subjects and instructional aids to be used. *

B. 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 A. *

C. Check the method of assessment to be used followed by a brief description in the box below. *

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

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

Standardized test results

Consultation with the Assistant Superintendent or appropriate School Principal

Any other method agreed to by both Assistant Superintendent and Home Educator(s)

C. Brief Description

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. CHINS Proceedings Pursuant to Massachusetts General Law Chapter 119, section 21, will not be invoked for any child pursuing a home education program.

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

Charles Decision

By typing your name in the below box, you are agreeing that all the information provided is accurate and true. The following signature confirms the intent to provide a minimum of 900-990 hours of instruction. *

Please upload any documents you would like to submit with your application.