Declaration of Intent Sample Form
The Declaration of intent form must be filed
annually. You need to by September 15 or within two weeks of the beginning of any public school quarter, trimester, or semester.
You need to request this form from the superintendent of the public school district that you reside, or a district that accepts
you as a transfer. It is best to get a stamped as received copy of the form or send it certified mail, to show they did in
fact receive it. The form should look very similar to this:
Declaration of Intent to Provide Home-Based Instruction
_______________________________
Public School District
_______________________________
Street Address
_______________________________
City, State Zip
I intend to cause said child(ren) to receive home-based instruction
as specified in RCW 28A.225.010(4);
Child(ren)'s Name(s)
Age
_______________________________ _______
_______________________________ _______
_______________________________ _______
[ ] A person certificated in Washington State pursuant to
chapter 28A.410 RCW will supervise the home-based instruction.
_______________________________ _____________
Signature
Date
_______________________________
Street Address
_______________________________
City, State Zip