Termination Form

To: The Superintendent of Schools Re: Notice of Termination of a Home Education Program

To whom it may concern: This letter is to inform you that the home education program for the following child(ren) has been terminated:

Child’s Name:

Date of Birth:

1. ________________________________________

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2. ________________________________________

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3. ________________________________________

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4. ________________________________________

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5. ________________________________________

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6. ________________________________________

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Home Address: _________________________________________________________________ _______________________________________________________________________________

__________________________________________ Parent Signature

_____________________________ Date