Home Study Program Declaration Of Intent

GEORGIA DEPARTMENT OF EDUCATION

STATE OF GEORGIA HOME STUDY PROGRAM DECLARATION OF INTENT FORM

Georgia law requires parents or guardians who teach their children at home to submit to the Georgia
Department of Education (GADOE) an annual Declaration of Intent form. A Declaration of Intent must be
submitted to the Georgia Department of Education within 30 days after establishment of a home study
program and by September 1 annually thereafter.

The parent or guardian shall have the authority to execute any document required by law, rule, regulation, or policy to
evidence the enrollment of a child in a home study program, the student’s full-time or part-time status, the student’s
grades, or any other required educational information. This shall include, but not be limited to, documents for purposes of
verification of attendance by the Department of Driver Services, for the purposes set forth in subsection (a.1) of Code
section 40-5-22, documents required pursuant to Chapter 2 of Title 39 relating to employment of minors, and any
documents required to apply for the receipt of the state of federal public assistance.

Learn more about the Dexter Mosely Act, which allows qualifying home school students in grades 6-12 to participate in
extracurricular activities in the student’s resident public school system. Home Schools (gadoe.org).

† SPECIAL ED. NAME OF STUDENT(S) AGE OF STUDENT(S)

 * *
† Indicate by checking the box next to the name of any student who is identified as or suspected of needing special education services.Please note
this section is optional.

* Information must be entered on all required fields. NOTE: First blank field line of student information is a required field.

The school year for this home study program is * to * . During this 12-month period, the Home Study program must
provide instruction equivalent to 180 days with each day consisting of 4.5 hours of instruction per day unless the child is
physically unable to comply. You may begin a home study program at any time during the calendar year. You may count
the days in a current school year that a student spends in public or private school as part of the 180 days. The beginning
date is always the date you intend to begin home schooling your student(s).

SIGNATURE OF DATE
PARENT/GUARDIAN: SUBMITTED:

PRINT NAME OF PHONE

PARENT/GUARDIAN:
* (Optional):

ADDRESS: * CITY:* STATE: ZIP:*

DISTRICT:* --- Please choose a district --- Academy For Classical Education Amana SCHOOL
YEAR
Academy West Atlanta Appling County Atkinson County Atlanta Heights (Optional):
Charter School Atlanta Public Schools Atlanta SMART Academy Atlanta
Unbound Academy Babies Can't Wait Bacon County Baconton Community
Charter School Baker County Baldwin County Banks County Barrow County
Bartow County Ben Hill County Berrien County Bibb County Bleckley County
Brantley County Bremen City Bright from the Start Brookhaven Innovation
Academy Brooks County Bryan County Buford City Bulloch County Burke
County Butts County Calhoun City Calhoun County Camden County Candler
County Carroll County Carrollton City Cartersville City Catoosa County
Charlton County Chattahoochee County Chattooga County Cherokee Charter
Academy Cherokee County Chickamauga City Cirrus Charter Academy City
Schools of Decatur Clarke County Clay County Clayton County Clinch County
Coastal Plains High School - Bulloch Campus Coastal Plains Charter School -
Candler Campus Coastal Plains Charter School - Coffee Campus Coastal Plains
Charter School - Grady Campus Coastal Plains Education High School -
Hazlehurst Campus Coastal Plains Education High School - Hinesville Campus
Coastal Plains Education High School - Kingsland Campus Coastal Plains
Education High School - Sylvania Campus Coastal Plains High School Coastal
Plains High School - Colquitt Campus Coastal Plains High School -
Douglas/Coffee Campus Coastal Plains High School - Evans Campus Coastal
Plains High School - Glynn Campus Coastal Plains High School - Long Campus
Coastal Plains High School - Lowndes Campus Coastal Plains High School -
McIntosh Campus Coastal Plains High School - Taylor Campus Coastal Plains
High School - Vidalia Campus Coastal Plains High School - Wayne Campus Cobb
County Coffee County Colquitt County Columbia County Commerce City Cook
County Coweta Charter Academy Coweta County Crawford County Crisp
County D.E.L.T.A. STEAM Academy Dade County Dalton Public Schools Dawson
County Decatur County DeKalb Brilliance Academy DeKalb County Destinations
Career Academy of Georgia (Virtual) Dodge County Dooly County Dougherty
County Douglas County Dream Academy Charter School Dublin City Dubois
Integrity Academy Early County Early Hearing Detection & Intervention Echols
County Effingham County Elbert County Emanuel County Ethos Classical
Charter School Evans County Fannin County Fayette County Floyd County
Foothills Regional High School Foothills Regional High School (Barrow-Russell
Campus) Foothills Regional High School (Barrow-Sims Campus) Foothills
Regional High School (Bibb Campus) Foothills Regional High School (Burruss
Campus Foothills Regional High School (Butts Campus) Foothills Regional High
School (Franklin Campus) Foothills Regional High School (Greene Campus)
Foothills Regional High School (Jackson Campus) Foothills Regional High School
(Jasper Campus) Foothills Regional High School (Lee Arrendale Campus)
Foothills Regional High School (Madison Campus) Foothills Regional High School
(Morgan Campus) Foothills Regional High School (Oglethorpe Campus) Foothills
Regional High School (Social Circle Campus) Foothills Regional High School
(Walton Campus) Foothills Regional High School - (Elbert Campus) Foothills
Regional High School - Fort Gordon YCP Foothills Regional High School - Fort
Stewart YCP Foothills Regional High School - Milledgeville YCP Foothills Regional
High School - Phillips Campus Foothills Regional High School - Virtual Program
Foothills Regional High School YCP Virtual Program Forsyth County Franklin
County Fulton County Fulton Leadership Academy Furlow Charter School
Gainesville City Genesis Innovation Academy for Boys Genesis Innovation
Academy for Girls Georgia Connections Academy (Virtual) Georgia Cyber
Academy (Virtual) Georgia Fugees Academy Charter School Georgia School for
Innovation and the Classics Gilmer County Glascock County Glynn County
Gordon County Graduation Achievement Center - Savannah Graduation
Achievement Center Charter High School Grady County Greene County Griffin-
Spalding County Gwinnett County Habersham County Hall County Hancock
County Haralson County Harriet Tubman School of Science & Technology Harris
County Hart County Heard County Henry County Heritage Preparatory
Academy School Heron Bay Academy School Houston County International
Academy of Smyrna International Charter Academy of Georgia International
Charter School of Atlanta Irwin County Ivy Preparatory Academy at Gwinnett
Ivy Preparatory Academy, Inc Ivy Preparatory Young Men's Leadership Academy,
Inc. Jackson County Jasper County Jeff Davis County Jefferson City Jefferson
County Jenkins County Johnson County Jones County Lamar County Lanier
County Laurens County Lee County Liberation Academy Liberty County Liberty
Tech Charter Academy Lincoln County Long County Lowndes County Lumpkin
County Macon County Madison County Marietta City Marion County McDuffie
County McIntosh County Meriwether County Miles Ahead Charter School
Miller County Mitchell County Monroe County Montgomery County Morgan
County Mountain Education High School Mountain Education High School -
Banks Campus Mountain Education High School - Bartow Campus Mountain
Education High School - Chattooga Campus Mountain Education High School -
 Cherokee Campus Mountain Education High School - Dawson Campus
Mountain Education High School - Fannin Campus Mountain Education High
School - Forsyth Campus Mountain Education High School - Franklin Campus
Mountain Education High School - Gilmer Campus Mountain Education High
School - Habersham Campus Mountain Education High School - Hall Campus
Mountain Education High School - Hill Center Campus Mountain Education High
School - Lumpkin Campus Mountain Education High School - Pickens Campus
Mountain Education High School - QUEST Campus Mountain Education High
School - Rabun Campus Mountain Education High School - Stephens Campus
Mountain Education High School - Union Campus Mountain Education High
School - White Campus Mountain Education High School -Murray Campus
Murray County Muscogee County Museum School Avondale Estates Newton
County Northwest Classical Academy Oconee County Odyssey Charter School
Oglethorpe County Pataula Charter Academy Paulding County PEACE Academy
Charter School Peach County Peachtree Hope Charter School Pelham City
Pickens County Pierce County Pike County Polk County Pulaski County Putnam
County Quitman County Rabun County Randolph County Resurgence Hall
Charter School Resurgence Hall Middle Academy Richmond County RISE
Preparatory Charter School Rockdale County Rome City SAIL Charter Academy -
School for Arts-Infused Learning Sankofa Montessori Savannah Exploratory
Charter Academy Savannah-Chatham County Schley County Scholars Academy
Charter School Scintilla Charter Academy Screven County Seminole County
SLAM Academy of Atlanta Social Circle City Southwest Atl. Christian Academy
Southwest Georgia S.T.E.M. Charter Academy Spring Creek Charter Academy
State Schools Statesboro STEAM Academy Stephens County Stewart County
Stone Mountain Charter School, Inc. Sumter County Talbot County Taliaferro
County Tattnall County Taylor County Telfair County Terrell County The Anchor
School The Community Academy for Architecture and Design Thomas County
Thomaston-Upson County Thomasville City Tift County Toombs County Towns
County Treutlen County Trion City Troup County Turner County Twiggs County
Union County Utopian Academy for the Arts Charter School Utopian Academy
for the Arts Trilith Valdosta City Vidalia City Walker County Walton County
Ware County Warren County Washington County Wayne County Webster
County Wheeler County White County Whitfield County Wilcox County Wilkes
County Wilkinson County Worth County Yi Hwang Academy of Language
Excellence Zest Preparatory Academy School

IMPORTANT: After submitting this form electronically it will create a 36 unique character parent signature line. This form with the 36 unique
character parental signature line is the official home study record that is required for a driver’s license/permit, work permit, and all other
documents related to your child’s educational needs.

Georgia Department of Education

Richard Woods, Georgia's School Superintendent

January 19, 2024 • Page 1 of 1

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