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COMPETENT PRIVATE INSTRUCTION REPORT
Iowa Code § 299.4
20__-20__ School Year
(Completed by the Parent, Guardian, or Legal or Actual Custodian)
Required information: See instructions before completing.
The following information is required in accordance with Iowa Code section 299.4. Parent, guardian, or legal or actual custodian must submit this report in duplicate to the school district of residence. This report is required if the student is 6 years old on or before September 15 and not yet 16 years old and does not attend an Iowa public or accredited nonpublic school. Return this form to the school district secretary by August 26 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 dually 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”)
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). Attach lesson plans on separate page(s).
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)
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COMPETENT PRIVATE INSTRUCTION REPORT
6) If an appropriately licensed Iowa teacher will provide or supervise the parent, guardian, or legal or actual custodian in providing the instruction, give the teacher’s name and folder number.
7)
8) If an Iowa licensed teacher is not providing instruction or supervising, the parent, guardian, or legal or actual custodian providing instruction to the child, the child must take an annual assessment. (Please see the acceptable annual assessments listed in this handbook, page 18). The school district will notify parents, guardians, or legal or actual custodians by October 1st of testing dates.)
Parent/Guardian/Legal or Actual Custodian Signature (required):
________________________________________________________________________________
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COMPETENT PRIVATE INSTRUCTION REPORT
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 complete the following #8 and #9. You may also choose to dually enroll your child to have your child’s annual assessment provided at no charge to you.
8) 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 unless the parent, guardian, or legal or actual custodian of the child does not consent to initial evaluation or to reevaluation of the child for receipt of special education services or programs. Iowa Code section 299A.9
Is the child currently identified as a child requiring special education pursuant to the rules of special education? Yes___No___
Have you consented to initial evaluation or to reevaluation of the child for receipt of special education services or programs? Yes____No_____
9) Do you desire dual enrollment in the public school for the child under competent private instruction? Yes ___ No ___ (If no, skip to #10.)
A. Dual enrollment is desired for:
B. Academic ____ Extra-curricular activities ____ Special Education ___ Testing___
(Check all that apply)
C. Grade Level for the 2011-2012 school year _________
D. Subjects or Activities you wish your child to dual enroll in:
10) Do you desire to enroll in a Home School Assistance Program if offered? Yes __ No ___
(Note: Dual enrollment information from page 13 in the CPI handbook).
Parent/Guardian/Legal or Actual Custodian Signature (required):
____________________________________________________________________________________________
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COMPETENT PRIVATE INSTRUCTION REPORT
Parents, guardians, or legal or actual custodians 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 August 26 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, guardian, or legal or actual custodian to provide the required information, items 1-6 and parent/guardian/legal or actual custodian signature. Item 7 is informational. Items 8, 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 (Link to Timeline) for an explanation of the dual enrollment deadline in the CPI handbook.)
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, guardians, or legal or actual custodians 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, guardians, or legal or actual custodians 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, guardian, or legal or actual 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 website www.boee.iowa.gov or by calling (1-515-281-3245). 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 evaluation/annual assessment requirement. (If parent/guardian/legal or actual custodian is a licensed teacher or working with a licensed teacher who holds a license appropriate to the age and grade of the child, the child is not required to take an annual assessment. If the child is enrolled in a private school accredited by a regional or national accrediting organization, the child’s annual report card can be submitted as a report of annual assessment. A courtesy test may be requested, see note in item number 7.)
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COMPETENT PRIVATE INSTRUCTION REPORT
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 evaluation in their first year of home schooling. Each year after the baseline evaluation, 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 or actual 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 for whom standardized testing has been selected as their method of annual assessment 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 and also on the website located at: http://educateiowa.gov/index.php?option=com_content&task=view&id=301&Itemid=1335.
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, guardians, or legal or actual custodians by October 1 of the dates, sites, and time of testing. If parents, guardians, or legal or actual custodians of a student subject to the assessment requirement request testing in their home, it must be provided at that site and at no cost to the parents, guardians, or legal or actual custodians if the child is dually enrolled. If the child is not dually enrolled, the school should advise the parents, guardians, or legal or actual custodians of the costs that will be charged to them (see FAQ #36 in the CPI handbook). If a portfolio is used as an annual assessment, the parent, guardian, or legal or actual custodian identifies the licensed teacher to evaluate the portfolio. The deadline for completing assessments or submitting portfolio to evaluator is May 1st of each year and the test administrator or portfolio evaluator must send a copy of the results to the parents, guardians, legal or actual custodians, 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-IAC 31.8(3)
Special note about “courtesy testing.” Occasionally, parents, guardians, or legal or actual custodians of children who are not subject to the baseline evaluation/annual assessment requirement may want their child tested anyway. As when an annual assessment is required, if the child is dually enrolled, the school or AEA must provide the testing free of charge to the parents, guardians, or legal or actual custodians.
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COMPETENT PRIVATE INSTRUCTION REPORT
Items 8, 9, and 10 are optional
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, or legal or actual custodian 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 However, this consent is not required if the parent, guardian, legal, or actual custodian does not consent to initial evaluation or to reevaluation of the child for receipt of special education services or programs.
Note: In order for a child who receives CPI to receive special education services, the child must be dually enrolled. (See Item 9)
Item 9: Dually enrolled students may participate in coursework or activities on the same basis as regularly enrolled students. This item is required if parents, guardians, or legal or actual custodians wish to have their children participate in an academic course or extracurricular activity. Dual enrollment is also required if the child is to receive special education programs or services. If parents, guardians, or legal or actual custodians want their child dually enrolled in a course or activity the course or activities need to be listed. Districts need to develop procedures to ensure that dually enrolled students and their parents, guardians, or legal or actual custodians are given adequate notice of the time and place of the activities they have chosen. The deadline for dual enrollment is September 15 if the parents, guardians, or legal or actual custodians 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 dually enrolled. (This item is designed to help districts determine if they need to start a program.)
SCHOOLS-Please give parents, guardians, or legal or actual custodians the FERPA (page 20 in CPI handbook) notification letter when a Form A is requested. Districts shall determine what directory information is and who the local contact is. When the parent, guardian, or legal or actual custodian gives “opt out” instructions to the school, the AEA’s have requested that the LEA send a copy to them.
PARENTS/GUARDIANS/LEGAL or ACTUAL CUSTODIANS-Please review the FERPA form and return to the school.