PHEN- home education affidavit

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Sample affidavit

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The parent, guardian or other person having legal custody must file a notarized affidavit with the superintendent of the school district of residence, prior to the commencement of the home education program and annually thereafter on August 1st. We have provided one such affidavit form below to be downloaded, filled in, notarized and filed with your school district.

There is no single 'official' version for the affidavit form mandated by the state. Families have the freedom to use the form of their choice or create one themselves. We suggest checking the requirements in act 169 before using an affidavit from any source.

Many school districts are 'requiring' birth date, grade level or social security numbers on affidavits. These are not requirements in Act 169.

Available here in 3 file formats for offline reading or printing. Everyone should be able to view at least one of them.
affidavit in .pdf (Adobe Acrobat) format.
affidavit in .doc (Word for Windows) format.
affidavit in .rtf (rich text) format.

Your notarized affidavit should include an outline of proposed education objectives by subject area and be accompanied by your medical papers or exemption.


Last Updated: August 1st, 2008
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