COMPETENT PRIVATE INSTRUCTION REPORT

Iowa Code § 299.4

20__-20__ School Year

 

 

Form A (Completed by the Parent)                                                               Date when returned___________

Required information:

 

Required Information:  See instructions before completing (pages 4-6).

The following information is required in accordance with Iowa Code section 299A.9.  Parent/Guardian must submit this report in duplicate to the school district of residence.  This report is required if the student is between the ages of 6 years old and 15 by September 15 and does not attend an Iowa public or accredited nonpublic school or is not enrolled in a home school assistance program operated by an Iowa public or accredited nonpublic school.  Return this form to the school district secretary by September 15 or within 14 calendar days of removing the student from a public or accredited nonpublic school or 14 calendar days from moving into the school district.  (If you are enrolled in a home school assistance program, please notify the district if you plan to dual enroll.)

 

1.       Child and Family Information: (Name and birth date of child under competent private instruction.)

 

Name:	Birth Date:

 

2.       Name and address of person filing report. (Please check the appropriate box after “name”)

 

Name:			Parent	Guardian	Legal Custodian
Address:		City, Zip:
Phone # (optional)

 

 

3.       Immunization Evidence:  If filing Form A for the 1st time, attach immunization information. 

(Proof of immunization is required of all children receiving CPI, including those enrolled in a HSAP)

 

 

4.       Instructional Program Information:

Outline the course of study on a separate page(s) as shown below.  Attach lesson plans on separate page(s).

Subject:

Text, Publisher, and Author:

Time Spent:

           

 

5.       List number of days of instruction under competent private instruction ____________ 

(Must be at least 148 days per academic year, Iowa Code section 299A.1).

 

 

6.       If an appropriately licensed Iowa teacher will provide or supervise the parent, guardian, or legal custodian in providing the instruction, give the teacher’s name and folder number.

 

Name:	Teacher Folder Number:
Address:	Teacher signature- (optional):
City, State / Zip:	Phone Number- (optional):

 

7.       If an Iowa licensed teacher is not providing instruction or supervising the parent, guardian, or legal custodian providing instruction the child must take an annual assessment.  (Please see the acceptable annual assessments listed in this Iowa Department of Education handbook:  http://tinyurl.com/52xj2t ).  The school district will notify parents by October 1st of testing dates.)

 

 

 

 

Parent / Guardian / Legal Custodian Signature:

 

The Following Information is Optional….

However, if you want your child to access special education programs or services,

Or if your child plans to participate in any academic or extracurricular activities at your local school district,

Or if you wish to have your child’s annual assessment provided at no charge, complete the following:

 

8.       Is the child currently identified as a child requiring special education pursuant to the rules of special education?  (281-31.2(1)”b”(2).        ______Yes     ______No

 

If the child is currently identified as a child requiring special education, prior approval must be sought from the special education director at the Area Education Agency before the child may receive Competent Private Instruction in Iowa.  Iowa Code section 299A.9

 

9.       Do you desire dual enrollment in the public school for the child under competent private instruction?

Yes ___ No ___  (If no, skip to #10.)

Dual enrollment is desired for:   (Check all that apply)

A.      Academic ____ Extra-curricular activities ____ Testing ____ Special Education ______         

       

B.      Grade Level for the 20__-___ school year _________

 

C.      Subjects or Activities you wish your child to dual enroll in:

 

1st Semester:	2nd Semester:

           

10.    Do you desire to enroll in a Home School Assistance Program if offered?  Yes _____  No  _____

 

Deadline for dual enrollment and/or Home School Assistance Program is September 15th, within 14 calendar days after moving to the district, or within 14 calendar days after removing the child from school.

 

Note: Due to the restrictions as to the number of students who may be served in a Home School Assistance Program, timely filed requests may be denied if the program already serves 20 families or 40 students per teacher.  281-IAC 31.3(3)

Parents with children under competent private instruction need to submit two copies of Form A to the local public school district. After the school district receives and checks the form for completion, one copy of the form should be filed with the local district and the other copy the district sends to the secretary of the AEA.   DO NOT SEND A COPY TO THE Department of Education.  NOTE: If you change your district of residence during the school year, you must also complete this form for your new district of residence.

 

The due date is the first day of school or no more than 14 calendar days after the child has been removed from an Iowa accredited school or after moving into the district,

 

The form is designed to allow the parent to provide the required information, items 1-6.  Items 7 and 8 are informational and items 9 and 10 are optional.  If you plan to dual enroll your child in an academic course or extracurricular activity, complete item 9.  (See the timeline page 8 in the handbook http://tinyurl.com/3vd6aq ) for an explanation of the dual enrollment deadline.)

 

Items 1& 2:  All information must be supplied. Only one child per form.

 

Item 3:   If filing Form A for the first time, attach immunization evidence. A child who begins home schooling/competent private instruction for the first time in Iowa (including children enrolled in a HSAP) must have received the required immunizations unless parents file a doctor’s statement or an affidavit of religious exemption as outlined in section 139A.8, Code of Iowa.  For exemption forms, please call 1-888-398-9696.

 

Item 4:   List the subjects taught, the texts used, the text publisher or author, and the amount of time spent on each subject listed. Parents need to attach the course of study information separately.  Lesson plans may be accepted for the entire year or for shorter periods of time.  The lessons should show evidence of planning.

 

Item 5: The number listed must be at least 148 school days.  Exception: If a child was enrolled in a public or accredited nonpublic school during the current academic year, then switched to home schooling, the number on this line may be the number of days remaining of the 148 school days after subtracting the number of days the child was in attendance in the school.

 

Item 6: In some situations, a person other than the child’s parent, legal guardian, or legal custodian either provides or supervises the instruction for the child. This person must hold a valid Iowa-teaching license appropriate to the age and grade of the child. The teacher’s name, address, and folder number must be provided in this item. The school district will check the licensure of this person by contacting the Bureau of Practitioner Preparation and Licensure, Iowa Department of Education at the following Web site: http://www.boee.iowa.gov/ or by calling (1-515-281-3245). An elementary classroom teacher license is appropriate for teaching or supervising home schooling in grades K-6; a middle school or secondary license is appropriate for grades 5-8, and a secondary classroom teacher license is appropriate for grades 7-12.  If item 6 is blank, and the child is between the ages of 7 and 15, inclusive, during the current school year, the child is subject to the baseline testing/annual assessment requirement. (If parent/guardian/legal custodian is a licensed teacher or working with a licensed teacher who holds a license appropriate to the age and grade of the child or if the child is enrolled in a private school accredited by a regional or national accrediting organization, the child is not required to take an annual assessment. A courtesy test may be requested, see note in item number 7.)

 

Item 7:  Children receiving competent private instruction are subject to the assessment requirement if they fit both of these criteria:

1.   AGE -- the child is between the ages of 7 and 15, inclusive, of the current school year.

2.   TEACHER -- the child’s instruction is not provided or supervised by a person holding a valid Iowa teacher license appropriate to the age and grade of the child.

 

All children fitting both criteria must have a baseline test in their first year of home schooling. Each year after the baseline test, as long as they still fit both criteria, they need an annual assessment of educational progress, which may be conducted using standardized testing, portfolio assessment, or a report card from an accredited correspondence school, Children under or over the age limits by September 15 are not subject to the annual assessment. Likewise, if an appropriately licensed Iowa teacher provides or supervises a parent, guardian, or legal custodian in providing the child’s instruction, the child is not subject to assessment, regardless of age.

 

Subjects that must be assessed:

 

●        For children up through grade 5: Reading, Language Arts, and Mathematics:

●        For children in grades 6-12: Reading, Language Arts, Mathematics, Science, and Social Studies.

 

Home-schooled children subject to the testing requirement must be tested annually in these subjects even if the school district does not test its own students.  National percentile ranks and national grade equivalents must be included on the score report from the test scoring service.

 

A detailed list of tests is in this handbook.  Schools or AEAs providing the testing should attempt to accommodate these preferences. Schools may provide the testing themselves or may delegate it to the AEA. Schools should notify parents by October 1 of the dates, sites, and time of testing. If parents of a dual enrolled student subject to the assessment requirement request testing in their home, it must be provided at that site. If a portfolio is used as an annual assessment, the parent, guardian, or legal custodian identifies the licensed teacher to evaluate the portfolio. The deadline for completing assessments is May 1st of each year and the test administrator or portfolio evaluator must send a copy of the results to the parents and the school district by June 30. An evaluator holding an elementary teaching license is appropriate for evaluating a portfolio for students in grades K-6, a middle school license for grades 5-8, and a secondary classroom teacher license is appropriate for grades 7-12.  281 l.A.C. 31.7(4)

 

Special note about "courtesy testing."  Occasionally, parents of children who are not subject to the baseline/annual assessment requirement may want their child tested anyway.  As when an annual assessment is required, if the child is not dual enrolled, the parents pay the costs.  If the child is dual enrolled, the school or AEA must provide the testing free, but need not provide a test, testing time, or testing site other than the one(s) established by the school for its regular enrollees.

 

Item 8: A child of compulsory attendance age, who is identified as requiring special education under chapter 256B and is receiving Competent Private Instruction, is eligible for placement under Competent Private Instruction with prior approval of the placement by the director of special education of the area education agency of the child’s district of residence. It is the duty of the parent/guardian to send a copy of Form A to the school district and the Area Education Agency Director of Special Education for approval. Iowa Code section 299A.9

Note:    In order for a child who receives CPI to receive special education services, the child must be dual enrolled. (See Item 9)

em numbers 9 and 10 are optional.

 

Item 9: Dual enrolled students may participate in coursework or activities on the same basis as regularly enrolled students. This item is required if parents wish to have their children participate in an academic course, extra curricular activity, or to have the standardized test paid for by the district.  Dual enrollment is also required if the child is to receive special education programs or services.  If parents/guardians/legal custodians want their child dual enrolled in a course or activity the course or activities need to be listed.  Districts need to develop procedures to ensure that dual enrolled students and their parents are given adequate notice of the time and place of the activities they have chosen. 

 

The deadline for dual enrollment is September 1 5 if the parents begin CPI at the start of the school year, 14 calendar days after moving, or 14 calendar days after withdrawing from school.  The district may deny dual enrollment if the request is after the deadline.

 

Item 10:  School districts are not required to offer a home school assistance program.  If your local school district has a program, students will be supervised by a licensed teacher that is hired by the school district.  To participate in courses or activities that are offered by the school, the child must be dual enrolled. (This item is designed to help districts determine if they need to start a program.)

 

SCHOOLS-Please give parents the FERPA notification letter when a Form A is requested.  Districts will determine what directory information is and who the local contact is.  When the parent gives “opt out” instructions to the school, the AEA’s have requested that the LEA send a copy to them.

 

PARENTS/GUARDIANS-Please review the FERPA form and return to the school.

 

UPLOAD FORM.