LEXINGTON COUNTY SCHOOL DISTRICT ONE

Instructional Services

100 Tarrar Springs Road

Lexington, SC 29072

APPLICATION FOR HOME INSTRUCTION

Date: ______

Please provide all information requested in this application. You must file a separate application for each child you wish to instruct at home. If your application is not approved, you have the right to appeal the decision to the Board of Trustees within ten days. Each application is approved for one school year only.

Please Check one of the following: Initial Application: Renewal Application:

STUDENT INFORMATION
Name of Student ______
Student’s Date of Birth ______Age ______
School Attended Prior Year ______
Grade Placement Prior Year ______Grade Placement Requested for HomeSchool ______
Name of Public School to Which Student May Attend ______

PARENTAL/GUARDIAN INFORMATION

Parent’s/Guardian’s Name ______
Street Address ______
City ______State ______Zip ______
Home Phone ______Cell Phone ______
Email Address ______
Name of Teacher ______
TEACHER QUALIFICATIONS. (Check highest earned.)
General Educational Development Certificate (GED).
High School Diploma.
Associate Degree
Bachelor’s Degree
A copy of the diploma or college transcript showing graduation must be attached to this application.

INSTRUCTIONAL PROGRAM

You must maintain the following documentation for each child you instruct:
  1. a written record of instruction in each subject area.
  2. a portfolio of the child’s work, (samples may be requested) and
  3. a record of evaluations you conduct.
It is also necessary that you provide to the school district reports of attendance and assessment twice during the year on forms which will be provided. You must schedule 180 days of instruction to include 4-1/2 hours of instruction per day exclusive of lunch and recess.
DATES OF OPERATION (You may use the school district’s calendar.)
Beginning Date ______Closing Date ______
Holidays ______Total Days ______

HOURS OF INSTRUCTION

Beginning Time ______Recess/Breaks ______
Lunch ______Ending Time ______Total Hrs.______, Min. ______

EVALUATION OF STUDENT PROGRESS/SEMI-ANNUAL REPORT

Semi-annual reporting system for attendance (180 days) indicating beginning date and ending date of home instruction:
First Semester Report: Beginning Date ______Ending Date ______
Second Semester Report: Beginning Date ______Ending Date ______
Semi-annual reporting system for academic progress or individual assessments in each State Required basic instructional area:
First Semester Report Card ( ) Date ______
Second Semester Report Card ( ) Date ______

STATE TESTING PROGRAM

Please indicate which option you prefer for your child’s participation in the State Testing Program. (Details will be provided prior to testing dates.) (Palmetto Assessment of State Standards, PASS, Grades 3, 4, 5, 6, 7, and 8; High School Assessment Program, HSAP, or Exit Exam, Grade 10 [[grades 11 and 12 if necessary]) End of Course Exams
for Algebra 1, English 1, US History, Biology
Public school testing
At home (You will be responsible for paying a fee.)
Does your child have any disabilities which will require special test materials or accommodations?
Yes
No
If yes, please explain. ______

TEXTBOOKS

Please provide the information requested for each subject. If any of this information changes after your initial application, you must submit the new information to the school district.
READING (grades 1-6)
Textbook ______Grade Level ______
Publisher ______Copyright Date ______
WRITING (grades 1-6)
Textbook ______Grade Level ______
Publisher ______Copyright Date ______
MATHEMATICS (grades 1-12)
Textbook ______Grade Level ______
Publisher ______Copyright Date ______
SCIENCE (grades 1-12)
Textbook ______Grade Level ______
Publisher ______Copyright Date ______
SOCIAL STUDIES (grades 1-12)
Textbook ______Grade Level ______
Publisher ______Copyright Date ______
LITERATURE (grades 7-12)
Textbook ______Grade Level ______
Publisher ______Copyright Date ______
COMPOSITION (grades 7-12)
Textbook ______Grade Level ______
Publisher ______Copyright Date ______
OTHER (Please name)
Textbook ______Grade Level ______
Publisher ______Copyright Date ______
OTHER (Please name)
Textbook ______Grade Level ______
Publisher ______Copyright Date ______
Please list other materials available for use (examples: encyclopedias, educational games, etc.).
______
Please explain what kind of record of instruction you plan to keep (examples: plan book, diary, etc.).
______
Please explain where instruction will take place in your home.
Please explain what kind of evaluation records you plan to keep (examples: tests, reports, etc.)
Samples of your child’s academic work must be maintained in a portfolio. Please describe the system you plan to use.
Please list the library facilities available for use by your child.

CONDITIONS OF RESPONSIBILITY

  1. I understand that, if the district determines that I am not maintaining the home school program in keeping with the standards set forth in state law and incorporated into this application, I will be so notified, and will have 30 says to correct any deficiencies. If I fail to correct the deficiencies, the board may withdraw approval of the program.
  2. I agree to hold the district, the district’s board of trustees, and the district’s employees and agents harmless for any educational deficiencies my child maintains as a result of home instruction.
  3. I understand that there is no guarantee that high school credits earned through homeschooling will be accepted by Lexington School District One for high school credit if my child subsequently enrolls in a public high school.
  4. I agree to the terms and conditions set forth in this application and agree to comply with the requirements of State Laws and regulations and district policies and regulations regarding home instruction
______
Signature of Parent or Guardian Date

OPTIONAL INFORMATION

The Board of Trustees is interested in the reasons parents choose home instruction. Please check as many as apply.
Religious
Expense of private school
Medical problem
Maturity
Learning differences
Dissatisfaction with school environment
Dissatisfaction with teachers / Dissatisfaction with administration
Curriculum not challenging
Curriculum not inclusive
Individual attention
Convenience
Too much work after school
Family relationships

Other ______

Comments ______

______

Applications are to be submitted, reviewed, and processed annually through the office of the Assistant Superintendent for Instruction. Supervision of the program will be provided through the same office.

______

District Official’s Signature (Signifying review of application) Date

For use by Lexington County School District One Personnel

Date of Parent Interview ______

Home School Liaison’s Signature ______

Approved ______Disapproved ______Date ______

Lexington County School District One does not discriminate on the basis of race, color, religion, national origin, sex, disability or age in admission to, access to, treatment in or employment in its programs and activities. The following people have been designated to handle inquiries or complaints. The Chief Human Resources Officer handles inquiries/complaints regarding Title IX. The Director of Middle Schools handles inquiries/complaints regarding Section 504. The Mathematics Coordinator handles inquiries/complaints regarding Title II. Contact these people if you have questions regarding these issues at 100 Tarrar Springs Road, Lexington, SC29072 and telephone number (803) 821-1000.

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