Letter of intent for Dade

(Date)______________________

Division of Student Services

Florida Home Education Program

489 East Drive

Miami Springs, FL 33166

Subject: Notice of Intent to Establish a Home Education Program

To Whom It May Concern:

In compliance with Section 232.02(4)(B)(1), Florida Statute, this serves as written notice of our intent to

home educate our child (ren). Please refer to the following for the information required by this law.

Child’s Name                             Birthdate                                        Social Security # (optional)

______________                      _____________                                _________________________

_______________                     _____________                              __________________________

_______________                   _______________                            ___________________________

_____________                        ______________                             ____________________________

Home Phone Number (optional):____________________________________________________________

Sincerely,

(Parent’s Signature)______________________________

(Parent’s Name- Please Print) ______________________