3114 Exhibit A - bsd405-2026

1. Click ‘Get Form’ to open it in the editor.
2. Begin by filling in the effective school year at the top of the form. This indicates when you plan to start home-based instruction.
3. In the 'Child(ren)’s Name(s)' section, enter the last, first, and middle names of each child who will be receiving home-based instruction.
4. Next, provide each child's birthdate and grade level in the designated fields to ensure accurate record-keeping.
5. Fill in your name as the parent or guardian, along with your street and mailing addresses. Make sure all information is clear and legible.
6. Indicate whether a certificated person will supervise the instruction by checking the appropriate box.
7. Finally, sign and date the form at the bottom to validate your declaration of intent before submitting it to Bellevue School District.

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