requirements of Florida Statute 1002.41(4). This home education student is registered with the ___________________________ County
OFFICE OF ADMISSIONS
Home Education Verification
Thank you for choosing to apply for admission to Daytona State College. In order to comply with the Florida Department of Education's
guidelines governing enrollment in college level courses, we must have the following verification completed and notarized.
Return this verification to the Admissions Office along with your Application for Admission. Students who wish to satisfy a foreign
language requirement using high school coursework are required to submit an official transcript demonstrating they have met the
requirement. If you are unable to complete this verification, you will not be eligible for enrollment until you receive a state-issued GED or
standard high school diploma.
This is to certify that my son/daughter is currently enrolled in / has graduated from a Home Education Program that meets the
public school district. I, , being duly sworn, declare under penalty of perjury, punishable by law as a
misdemeanor, that the foregoing is true and correct.
* Please attach proof of registration with the county.
(Name of County)
(Name of Parent / Legal Guardian)
Parent or Legal Guardian Signature
Date
Sworn to and subscribed before me this___________________day of ____________________ .
(Month and Year)(Day)
Signature, Notary Public Date Commission Expires
FLORIDA HOME SCHOOL
NOTARY
Notary Stamp
12/8/2014 bah
STUDENT INFORMATION
Student Name:
(CIRCLE ONE)
Student ID number:
OUT OF STATE PROGRAM
This is to certify that my son/daughter has graduated from a Home Education Program that meets the school attendance policy and state
law as defined by ______________statute of the state of _________________________. I,__________________________, being
duly sworn, declare under penalty of perjury, punishable by law as a misdemeanor, that the foregoing is true and correct.
*Please attach proof of registration with the local secondary school board if state law requires registration. Include a copy of the law and
statute defining home school from student's home state.
DateParent or Legal Guardian Signature
Graduation Date ( if applicable):
