Follow up Reporting Form

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Due Oct 1 to your school district office (Superintendent's office or Homeschool Liaison).

Use this form each year after your initial reporting (include additional children who are now 7 by Oct 1, or when you begin homeschooling a child older than 7).Your district may also require immunization documents for the added names and a form for reimbursement of testing fee, textbooks or workbooks (up to a maximum $ per child that changes from year to year). Check with your district or on their website for these additional forms.





City:________________________________ , MN   Zip:_______________________

Is this an Address change? Y  N

This submission indicates our intent to continue homeschooling in the district. Our initial reporting form and immunization records are on file from previous submission. Any changes are noted below.

ADDITIONAL CHILDREN TO REPORT:       Only children ages 7-16 on Oct 1 and not previously reported need to be listed.

Name                                                                                    birthdate                           Immuniz record attached






IMMUNIZATION RECORD UPDATE:         for children who have reached 7th grade/ 12 yrs of age.

Name                                                                                    birthdate                           Immuniz record attached





We will assume agreement on our testing choice unless we receive written notification from the superintendent’s office within 10 business days.

Administered by:________________________________________________________________


Children to be tested with this assessment:___________________________________________

(if different tests will be used for some children in the household, list all testing info on this form or use the back side). 



Use this form each Oct 1 if you reside in the same district as your initial filing. If you have moved, you must notify your previous district within 15 days and file the initial reporting form by Oct 1 in your new district.

                             Always keep a copy for your records.