Application for Approval of Home Instruction

Piedmont Home Educators’ Association

Application for Approval of Home Instruction Under Section 59-65-47 School Year “2015 - 2016”

115 Buist Avenue, Greenville, SC 29609 www.phea.org 864-268-6880

Parent(s) or Guardian(s) ______

Last Name First MI

______

Last Name First MI

Street Address ______

Street

______

City State Zip

Mailing Address (if different) ______

Street

______

City State Zip

Home Phone (______)______E-mail Address______

Public school district in which your home school is located: ______

(Specify county and district number – some counties –including Greenville - have no number)

Does the Parent/Guardian have a high school diploma? YES NO GED? YES NO

(NEW APPLICANTS must send a copy of diploma/GED with application)

Check all appropriate boxes:

⁭ÿ I am withdrawing my student(s) from public school

⁭ÿ I am withdrawing my students from private school

⁭ÿ Other (please specify) ______

⁭ÿ I am renewing with PHEA

ÿ My students have previously been registered with PHEA (Family name registered under) ______

(Please note: When withdrawing children from public school, the parent/teacher should show a copy of the membership certificate to the local school(s).)

Answer all questions. If the answer to any of these questions is “yes”, please submit an explanation on a separate sheet of paper.

· Has this student been truant, suspended, or expelled from public or private school? ______

· Do both parents (or if single parent, do you) work outside the home during the day? ______

If so, how do you plan to manage supervision of your students? (Children should NOT be home alone.)

· In the past year, have you had any contact with any local authorities concerning your home school? ______

2015/2016

Name(s) of child(ren) to be home schooled School Grade Level In relation to this student I am:

(eg: 5th or 5/6th ) (each person listed on parent/guardian lines must initial)

______Parent ______Guardian ______

For Office Use Only date rec’d ______fees pd _$______diploma on file y n

missing ______

DECLARATION OF COMPLIANCE

For our students to be members of the Piedmont Home Educators’ Association, we understand and agree that we are the persons ultimately responsible for their education and the maintenance of their required records. In keeping with this, we agree to do the following for the full duration of my student(s) annual membership with the Association:

I. Adhere to the following requirements of Section 59-65-47 of the 1976 SC Code of Law:

A. The parent/teacher must hold at least a high school diploma or the equivalent general educational

diploma (GED).

B. The instructional year must be at least 180 days.

C. Curriculum (provided by me/us) must include at least the minimum of the basic instructional areas of reading, writing, mathematics, science and social studies; and, in grades seven through twelve, composition and literature.

D. Educational records shall be maintained by the parent/teacher (not PHEA) and include the following:

1. a plan book, diary or other record indicating subjects taught and activities in which the students and parent-teacher participate;

2. a portfolio of samples of the student's academic work; and

3. a semiannual progress report including attendance records and individualized documentation of the student's academic progress in each of the basic instructional areas specified in item C above (reading, writing, mathematics, etc.).

II. Agree to uphold the required standards of the Piedmont Home Educators’ Association, exercising diligence in all school business and instruction.

III. Keep a copy of the parent/teacher’s diploma, GED or higher education degree in personal files.

IV. Agree to notify PHEA’s office immediately in writing should there be any change in our home school situation or any change to information submitted on the membership application.

V. Acknowledge that I/we are solely responsible for my/our child/children's education.

VI. Agree to notify PHEA’s office of all school district, SC Department of Education, SC Department of Social Services or Law Enforcement Agency contacts regarding our home school within 24 hours of such inquiries.

VII. Understand that should any question regarding our home school arise from state or local authorities, a more complete review of student records may be necessary in order for PHEA to verify our compliance with statute 59-65-47. Agree to submit any or all educational records required by above statute for review by PHEA within 72 hours of request.

We understand that failure to fulfill any one of these association or statutory responsibilities may result in probationary status or dismissal from Piedmont Home Educators’ Association due to non-compliance.

I/We certify all of the information on this form (both sides) is complete and true to the best of my/our knowledge. If any information above is found to be false, my/our membership may be voided.

______

Signature Date Signature Date

The yearly fees for PHEA are as follows:

⁭ Registration...... (per family; NOT per child) for one year...... $_50.00

⁭ Late fee (for renewing families only, if mailed after July 31) ...... $15.00 $ ______

⁭ High school student fee ...... $10.00 (or $5.00) per student X ______students = $ ______

Total $ ______

We encourage families to submit the high school records via email. (Fee/student is $5 if the class ranking form is emailed.) The form is available on our website. Please email to

Check here if high school info was submitted via email _____

PHEA reserves the right to refuse any application for membership.

Applications can not be processed unless all questions are answered, documents submitted and diploma is on file.