Dear Student:
Thank you for choosing to apply for admission to Palm Beach State College. In order to comply with the Florida
Department of Education guidelines governing enrollment in college-level courses, we must have the following
affidavit completed and notarized.
HOME EDUCATION GRADUATION AFFIDAVIT
This is to certify that ____________________________ ____________ has graduated from a Home Education Program that
(Print Student’s Name) (Date of Birth)
meets the requirements outlined in Florida Statute 1002.41. This Home Education student is registered with ______________
(County)
Florida public school district. Attach verification of enrollment from school district’s Home Education Office.
I, being first duly sworn, declare under penalty of perjury punishable by law as a misdemeanor that the foregoing is true and
correct.
Dated this ________ day of ____________________, 20 _____. __________________________________________
(Parent or Legal Guardian)
__________________________________________
(Student)
NOTARY (FOR THE STUDENT SIGNATURE):
The foregoing instrument was acknowledged before me this _________ day of ____________________, 20 _______, by
_______________________________________, the student, who has produced identification by driver’s license or
__________________________ as identification, and who did sign this Affidavit under oath.
____________________________________________________________ [stamp/seal]
Notary Signature
____________________________________________________________
Notary Name (Printed)
Commission Expires: ____________________________________
NOTARY (FOR THE PARENT/LEGAL GUARDIAN SIGNATURE):
The foregoing instrument was acknowledged before me this _________ day of ____________________, 20 _______, by
_______________________________________, the parent/legal guardian, who has produced identification by driver’s license
or __________________________ as identification, and who did sign this Affidavit under oath.
____________________________________________________________ [stamp/seal]
Notary Signature
____________________________________________________________
Notary Name (Printed)
Commission Expires: ____________________________________
You must return this letter to the Admissions Office along with your admission application in order to receive a
Conditions for Admissions form and obtain academic advising. If you are unable to complete a notarized affidavit,
you will not be eligible for enrollment until you receive a state-issued General Education Diploma (GED).
If you have any questions about your current status, please feel free to contact any campus registrar’s office. We look
forward to your upcoming enrollment.
Belle Glade Boca Raton Lake Worth Palm Beach Gardens
1977 College Drive 3000 Saint Lucie Avenue 4200 Congress Avenue 3160 PGA Boulevard
Belle Glade, FL 33430 Boca Raton, FL 33431 Lake Worth, FL 33461 Palm Beach Gardens, FL 33410
(561) 993-1121 (561) 862-4340 (561) 868-3300 (561) 207-5300
