To: The Superintendent of Schools

Re: Notice of Intent to Establish and Maintain a Home Education Program

To Whom It May Concern:

This letter is to inform you of our intent to establish and maintain a home
education program for our child(ren), according to Florida Statutes 1002.41.

Child(ren)’s Name(s): Date of Birth:

1. ________________________________________ _____________________________

2. ________________________________________ _____________________________

3. ________________________________________ _____________________________

4. ________________________________________ _____________________________

5. ________________________________________ _____________________________

6. ________________________________________ _____________________________

Home Address: _________________________________________________________________

Telephone Number:__________________________________

Parent's Printed Name:_________________________________________________________

Parent Signature: _____________________________________________________________

Date: _____________________________________________

255 East Drive, Ste. H 1-877-ASK-FPEA

Melbourne, FL 32904 www.FPEA.com
*Mail letter of intent to County Superintendent's Office.