Subsequent Notice of Intent to Homeschool

This notice is for children who did homeschool in Maine during the previous school year.

Parent/Guardian Name

___________________________________________________________________________

Mailing Address

____________________________________________________________________________

City, Zip Code

This is to inform you of my intent to continue educating the following child(ren) in a home

instruction program pursuant to Maine Revised Statute Annotated title 20-A, §5001-A, sub-

§3.A.(4)(c).

I have enclosed an assessment for each child.

Please return completed and signed form to:

Randy J. Kassa

Homeschool Enrollment

Maine Dept. of Education

23 State House Station

Augusta, ME 04333-0023

Please send a copy to your local Superintendent of Schools.