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Clark County School District

Notification of Intent to Home School Form

(Pursuant to NRS 392.070 & NAC 392.015 through 392.075)

 

For office use only:  Date to Board____________________________________

 

 

 

STUDENT NAME_____________________________DATE OF BIRTH_____________________

 

SCHOOL YEAR TO BE EXEMPTED_____________EXEMPTION GRADE_________________

 

LAST SCHOOL ATTENDED OR HOME  SCHOOLING_________________________________

 

PARENT(S) / LEGAL GUARDIAN(S)__________________________________________________

 

ADDRESS____________________________________PHONE______________________________

 

CITY_____________________________________________ZIP___________________________

 

Phone_________________________________

 

 

 

EQUIVALENT EDUCATION AND EDUCATIONAL GOALS

I, as a parent / legal guardian, agree to assume full responsibility to provide equivalent instruction at home of the kind and amount approved by the Nevada State Board of Education  (NRS 392.070)  to constitute equivalent instruction, the instruction to be given a child outside the public school must include instruction in the courses of study prescribed by the state board or eduation pursuant to NRS 385.110.  The courses of study prescribed by the state board must comply with the standards of content and performance as found on the Nevada State Department of Education website at www.nde.state.nv.us and grade level curriculum overviews available in the CCSD homeschooling office. 

 

[  ]   Instruction and appropriate curriculum will be provided to teach the Nevada State standards.  [NAC 392.025(1)]

 

Parent / Legal Guardian Signature ________________________________Date_______________

 

 

SELECT INSTRUCTIONAL OPTION

 

[   ]  OPTION A BY PARENT

Parent has previously home schooled and is requesting an exemption for another year.

 

            _______________________  ________________________            ___________________

                      Previous years                            City                                          State

        If previous home schooling was done out of district, documentation will need to be provided.

             [  ] OPTION B  CONSULTANT

 

                     1.  [  ]  By the Parent in Consultation / Consultant

Instruction is provided in consultation with threea parent who has home schooled for at least three years.  NAC 392.011 (2)  “Consultation means:

1) Participation by the consultant in the preparation of the educational plan for the child

2) Participation by the consultant in the development or review of the subjects to be taught; and

3) Consultation with the parent about any learning problems which may occur.

 

THE DISTRICT DOES NOT ENDORSE ANY CONSULTANT.  INFORMATION ON CONSULTANTS IS AVAILABLE IN THE HOMESCHOOLING OFFICE.

 

 

Home Educator Consultant:

I will provide consultation in the following areas: (a) assistance in meeting the educational standards,  (b) be available to the parents9s) to discuss any problems which may occur during the 2002-2003 school year.

 

I, ________________________, am a Home Educator Consultant with ___________ years experience.  I have home schooled at the elementary/secondary grade level in__________________________________________

                                    (CITY/STATE)

 

____________________________________________________________________________     Signature of Home Educator Consultant                                               Phone number

 

OR

 

                        2. [  ]  By parent in consultation / teacher

            Instruction is provided in consultation with a Nevada licensed teacher who is licensed for the grade to be taught.

           

            Licensed Teacher:

 

I, ______________________________, am licensed to teach in Nevada with endorsement in 

 

 [  ] elementary   [  ]  secondary subjects, license  #_____________________ an expiration date

 

of ______________________.  __________________________________________________

Signature of licensed teacher with copy of license

 

[  ] OPTION C PARENT/ GUARDIAN LICENSED TEACHER

Instruction from the child’s parent if, the parent qualifies for a teaching license from any state or territory of the United States for the grade to be taught.  (attach copy of license)

___________________________________     __________________   __________________                  Name                                                         License number                        Expiration date

[  ] OPTION D STATE BOARD APPROVED CORRESPONDENCE PROGRAM

Instruction by the parent when the child is enrolled in an approved correspondence program.  A LIST OF APPROVED CORRESPONDENCE PROGRAMS APPROVED BY THE NEVADA DEPARTMENT OF EDUCATION IS AVAILABLE IN THE HOMESCHOOLING OFFICE. 

 

 

            Name of approved correspondence program with enrollment verification

 

 

 

 

 

 

CALENDAR OF DAYS

Nevada regulations require you to provide 180 days of instruction during the school year.  You may choose any 180 days during the year from July 1st  to June 30th .

Total Days___________________

 

July  _____________ Days         Nov ___________ Days                  Mar ____________Days    

Aug _____________ Days          Feb ____________Days                 Apr ____________Days 

Sept _____________Days           Dec ___________ Days                May ____________Days

Oct ______________Days          Jan ____________Days                June ____________Days

 

 

A school day in session must consist of the following minimum daily periods for each grade, including recess and time between activities, but not including the time allowed for lunch.  (NRS 387.131)

 

 

Please check the one you are using.

Kindergarten 120 minutes a day _____             1st and 2nd  240 minutes a day _____

3rd thru 6th      300 minutes a day _____                        7th thru 12th 330 minutes a day _____

 

 

Ruturn Notification Packet IN PERSON with identification to receive letter of exemption:

 

 

Central Student Services

Home Schooling Department

2701 E. St. Lous Avenue

Las Vegas, NV 89104-4214

(702) 799-8636 x330

           

If student has never been enrolled in CCSD

Birth Certificate must be submitted

Instructional Materials

Make a list of textbooks, including titles and authors, as well as other books or materials that you will be using to Nevada State Standards.  You may list encyclopedia sets, educational games, computer software, musical instruments, are supplies, microscope and slides, time lines, magazines subscriptions, the public library or other resources.  (Parents have the right to use additional materials to teach concepts beyond the scope of state standards.)