3114F Form - Declaration of Intent to Homeschool

FPS Logo
Assistant Superintendent’s Office
315 129th Street South, Tacoma, WA, 98444-5099
 (253) 298-3021/FAX (253) 298-3015
A parent who intends to cause his/her child(ren) to receive home-based instruction in lieu of attendance or enrollment in a public school, approved private school or an extension program of an approved private school must file an annual declaration of intent to do so in the format prescribed below:
I do hereby declare that I am the parent, guardian or legal custodian of the child(ren) listed below; and that said child(ren) is/are between the ages of 8 and 18 and as such are subject to the requirements found in chapter 28A.225 RCW Compulsory Attendance; I intend to cause said child(ren) to receive home-based instruction as specified in RCW 28A. 225.010(4); and, if a certificated person will be supervising the instruction, I have indicated this by checking the appropriate space.
          Child(ren)’s Name(s)                                                                               Birthdate           
(   )  The home-based instruction will be supervised by a person certificated in Washington State
 pursuant to Chapter 28A.410 RCW.
Parent Name (Please Print):                                                                                                     
Parent Signature:                                                                                                                       
City:                                                                         State: __________ Zip:                                   
This statement 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 where the parent resides.
Return signed and completed form to:
Email: enrollment@fpschools.org
Fax: (253) 298-3015
Mail: Franklin Pierce Schools - Deputy Superintendent 315 129th St S, Tacoma, WA 98444