Letter of Intent to Continue to Provide Instruction

Letter of Intent to Continue to Provide Instruction
Per Minnesota Statutes, section 120A.24, subdivision 1(b), the person or nonpublic school in charge of providing instruction to a child between the ages of seven and 16 through 17 for which an initial registration form was filed pursuant to this subdivision must submit, by October 1 of each school year, a letter of intent to continue to provide instruction under this section for all students under the person’s or school’s supervision and any changes to the child’s name, birthday, address of the child and the annual tests intended to be administered.

Complete the information using this form or a written or electronic format of your choice. If you have moved, you must file a new Initial Registration Form for Unaccredited Schools, Including Home-School. Information in the Letter of Intent must be submitted to the school district by October 1 of each year after an initial registration form has been filed in the same district. Please do not mail the letter of intent to the Minnesota Department of Education.
Date of Letter of Intent to Continue to Provide Instruction (mm/dd/yy)*

MonthDayYear
Date
Date Initial Registration Form was filed with this School District (mm/dd/yy)*

MonthDayYear
Date
Full Legal Name of Instructor (Last, First, Middle)*
This letter indicates my intent to continue to provide instruction in the current school year.*

I DO NOT have changes to the information provided in the initial registration form or communicated in a previous Letter of Intent to Continue to Provide Instruction.I DO have changes to information provided in the full initial registration form, and have updated the information as follows:I have added students or student contact information has changed. (Update ‘New Students or Updated Student Information’ on page 2 and ‘Proposed Testing Plan’ on page 3. Attach immunization records or notarized conscientious objection statement.)‘The proposed annual nationally normed achievement-testing plan for one or more students has changed. (Complete Proposed Testing Plan’ on page 3.)Student is now in 7 grade and/or age 12. Provide student’s name and date of birth below. Attach updated immunization records or notarized conscientious objection statement.)I have discontinued instructing student(s) previously reported. (Update ‘Students No Longer Being Instructed’ in the table below.)My primary instructor qualifications changed. (Attach explanation and documentation as required in the initial registration form.)My primary or secondary instructor contact information changed. (Update ‘Instructor Contact Information’ below).We are no longer accredited by an agency recognized by the Minnesota Nonpublic Education Council.We are newly accredited by an agency recognized by the Minnesota Nonpublic Education Council. (Update ‘Accrediting Agency Information’ below.)
Link to Minnesota Nonpublic Education Council
Attach immunization records, notarized statement of conscientious objection for student (2) if box 3 or 5 checked, or Minnesota teaching license, baccalaureate diploma or degree if instructor qualification changed (if box 7 checked)

Cancelof

New Student(s) or Updated Student Information*

	Student(s) Full Legal Name	Date of Birth (mm/dd/yy)	Address	Phone Number

Student(s) No Longer Instructed

	Student(s) Full Legal Name	Date of Birth (mm/dd/yy)	Address	Phone Number

Instructor Contact Information*

	Full Legal Name (Last, First, Middle)	Street Address	Phone Number (including area code)	Email Address
Primary Instructor
Secondary instructor (if applicable)

Accrediting Agency Information

	Name of Accrediting Agency, Address and Contact Information	Dates of Accreditation Term

Proposed Annual Nationally Normed Achievement Test, Assessment or Examination Plan

Instructors and superintendent must mutually agree on the proposed annual nationally normed achievement test(s), assessement(s) or examination plan, the administration and the location of the examination. MDE recommends families consider the Iowa Assessments, available through the University of Minnesota Statewide Testing Program, (612) 626-0006.

	Nationally Normed Achievement Test	Student Name	How will the test be administered and who will be the administrator	Test Location	DISTRICT USE Superintendent AGREES to this plan for the student(s) in the years specified	DISTRICT USESuperintendent DOES NOTAGREE: Contact instructor immediately

Maintaining and Submitting Documentation and Scores
Per Minnesota Statutes, section 120A.24, subdivision 2, the person or nonpublic school in charge of providing instruction to a child must maintain documentation indicating that the subjects required in section 120A.22, subdivision 9, are being taught and proof that the tests under section 120A.22, subdivision 11, have been administered. This documentation must include class schedules, copies of materials used for instruction, and descriptions of methods used to assess student achievement.

The parent of a child who enrolls full time in public school after having been enrolled in a nonpublic school that is not accredited by a state-recognized accrediting agency must provide the enrolling public school or school district with the child's scores on any tests administered to the child under section 120A.22, subdivision 11, and other education-related documents the enrolling school or district requires to determine where the child is placed in school and what course requirements apply. This paragraph does not apply to a shared time student who does not seek a public school diploma.

The person or nonpublic school in charge of providing instruction to a child must make the documentation in this subdivision available to the county attorney when a case is commenced under section 120A.26, subdivision 5; chapter 260C; or when diverted under chapter 260A.
Signature (electronic or physical signature)
Print or Type Name of Person Submitting this Letter*
Signature*

Clear
Date*

MonthDayYear
Date
Should be Empty:

Letter of Intent to Continue to Provide Instruction

Maintaining and Submitting Documentation and Scores

Signature (electronic or physical signature)