Parent Name
Parent Address
Parent Town, NH xyzzy
Parent Phone #
Dr. ABC, Superintendent                                  
c/o SAU #xyz                                             
SAU Address                                              
SAU Town, NH  xyzzy                                      
Dear Superintendent,
 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 during the XXXX-XXXX school year:
    Student Name
    Student Address
    Student Town, NH xyzzy
    Student DOB
 Our program will begin on ________, XXXX.
 We look forward to receiving your written acknowledgement. Should you have any
questions or comments, we can be reached at the above address and phone number.
 We do not authorize the release of any information contained in this notice
except as specifically provided by law.  By this notice we are not waiving our
rights under the United States and/or New Hampshire constitution as amended.
All information provided herein is privileged and confidential.  Any disclosure
requires written parental consent prior to such disclosure.
     Signed:  _________________________  Date: ________________
     Printed: _________________________
Receipt of Homeschool Notification Acknowledged by Participating Agency:
     Signed:  _________________________  Date: ________________
     Printed: _________________________

Please note that 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).