Initial Registration Form for Unaccredited Nonpublic Schools (including homeschools)

Initial Registration Form for Unaccredited Nonpublic Schools (including homeschools)
The person or nonpublic school in charge of providing instruction to a child must submit an Initial Registration Form for Unaccredited Nonpublic Schools (including homeschools), to the superintendent of the school district where the child resides. Please do not mail the registration form to the Minnesota Department of Education. Find your resident school district name, number and contact information here: LCC-GIS (mn.gov). Complete the information using this form or a written or electronic format of your choice. You will submit a Letter of Intent to Continue to Provide Instruction by October 1 in subsequent years.

Per Minnesota Statutes, section 120A.24, subdivision 1, Information in the registration form must be submitted:
- By October 1 of the first school year the child receives instruction after reaching the age of seven;
- Within 15 days of when a parent withdraws a child from public school after age seven to provide instruction in a nonpublic school that is not accredited by a state-recognized accredited agency;
- Within 15 days of moving out of a district; and,
- By October 1 after a new resident districts is established.
Instructor(s)

Primary Instructor Contact Information
Full Legal Name (Last, First, Middle)*
Street Address (No P.O. Box)*
Home Phone (Including Area Code)*
Other Phone (Including Area Code)
Email Address*
Secondary Instructor Contact Information
Full Legal Name (Last, First, Middle)
Street Address (Including Area Code)
Home Phone (Including Area Code)
Other Phone (Including Area Code)
Email Address
Evidence of Instructor Qualifications
A person who is providing instruction to a child must meet at least one of the following requirements per Minnesota Statutes, section 120A.22, subdivision 10:

Minnesota Statutes, section 120A.22, subdivision 11
The instructor holds a valid Minnesota teaching license in the field and for the grade level taught. (Attach a copy of the license.)The instructor is directly supervised by a person holding a valid Minnesota license. (Attach a copy of the license.)The instructor holds a baccalaureate degree. (Attach a copy of diploma/degree)The instructor is the parent, guardian or other person having legal custody of a child who is assessed according to the procedures in Minnesota Statutes, section 120A.22, subdivision 11.
Attach Minnesota teaching license, baccalaureate diploma or degree

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Student(s)

Please complete the table below attach additional sheets, as needed*

	Student(s) Full Legal Name	Date of Birth (mm/dd/yyyy)	Address	Phone Number
1
2
3

Immunization Records
Per Minnesota Statutes, section 121A.15, subdivision 8, please attach immunization records or notarized statement of conscientious objection for each student. Update immunization information when each student reaches 7th grade.
Attach immunization records or notarized statement of conscientious objection for each student

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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) assessment(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 the test will 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 USE Superintendent DOES NOT AGREE: 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)
Type or Print Name of Person Submitting this Letter*
Instructor Signature*

Clear
Date*

MonthDayYear
Date
Should be Empty:

Initial Registration Form for Unaccredited Nonpublic Schools (including homeschools)

Instructor(s)

Evidence of Instructor Qualifications

Student(s)

Immunization Records

Proposed Annual Nationally Normed Achievement Test, Assessment or Examination Plan

Maintaining and Submitting Documentation and Scores