Your Names

Address

Phone Number

- SAMPLE -

Superintendent                              

SAU #        

Address

Town/City, NH  Zip Code

Dear Superintendent                              :                                  Date:

In accordance with New Hampshire RSA Chapter 193-A:5 and Administrative Rules Ed 315.04(a), this letter serves to notify you of the home education program for our child(ren), beginning month, date, of the 20XX/20YY school year:

            Child(ren):                                                        DOB:

            A                                                                     MM/DD/YY

            B                                                                     MM/DD/YY

Curriculum information is no longer a required home education program notification component pursuant to HB406 (effective May 12, 2006) and Ed 315.04.  Notification shall include only the following:

(a)    name, address, and birth date of the child participating in the home education program;

(b)   beginning date of the home education program; and

(c)    name, address, and telephone number of parent(s).

We do not authorize the release of any information contained in this notice except as specifically provided by law. All information provided herein is considered privileged and confidential.  Any further disclosure of this information requires written parental consent prior to such disclosure.  By this notice we are not waiving our rights under the United States and/or New Hampshire constitution as amended.

______________________________                        _______________________________

Your Name, Date                                                         Spouse’s Name, Date