Bay District Schools
1311 Balboa Avenue 
Panama City, Florida 32401 

Attn:  The Superintendent of Schools
Re:  Notice of Intent To Establish A Home Education Program

In compliance with Section 232.02(4)(B)(1), Florida Statute, this serves as 
the written notice of intent to home educate.  Please refer to the following 
for the information required by the law.

Child's Name (Please Print Clearly)                         Birth date:

1. _____________________________________________  	_______________

2. _____________________________________________  	_______________

3. _____________________________________________  	_______________

4. _____________________________________________  	_______________

5. _____________________________________________  	_______________

6. _____________________________________________  	_______________

Home Address:	__________________________________________________

		__________________________________________________


__________________________________
Parent’s Name (Please Print)

__________________________________
Parent Signature

__________________________________
Date

WRITTEN EVALUATION FORM
 
Upon review of the portfolio and discussion with the pupil named below, I have found that
the pupil has demonstrated progress at a level commensurate with his/her ability and is
ready to be promoted to the next level.
 
_________________________________________________________
Name of Florida Certified Teacher/Evaluator (Please Print)
 
_________________________________________________________
Signature of Florida Certified Teacher/Evaluator
 
_________________________________________________________
Certification Number
 
_________________________________________________________
Date of Expiration
 
 
PLEASE PRINT:
 
Pupil's Name:_______________________________________________
 
Pupil's Birthdate:_____________________________________________
 
Pupil's Address:______________________________________________
 
		______________________________________________
 
 
__________________________________________________________
Parent’s Name (Please Print)
 
__________________________________________________________
Signature of Pupil's Parent(s) or Guardian(s)
 
__________________________________________________________
Evaluation Date
 
RETURN TO:		Bay District Schools
			Nelson Administrative Building 
			1311 Balboa Avenue
			Panama City, FL  32401
			
Attn:  The Superintendent of Schools
Re:  Home Educator’s Annual Evaluation