HomeSchool Enrollment Form

HOMESCHOOL ENROLLMENT FORM

This form pertains only to the residents of the State of Indiana.

Contact Information: homeschool@doe.in.gov or 317-232-0957

Only parents and legal guardians may complete this form.
Please include your child’s name, date of birth and grade on this form.

PLEASE NOTE THAT YOU WILL NOT RECEIVE A BOOK OR A CURRICULUM AS A RESULT OF FILING THIS FORM WITH US

Make sure to verify your responses before clicking the submit button. You will not be able to make any changes after submitting homeschool enrollment report form.

*Indicates required fields
* Parents First Name:	* Parents Last Name:

* In what public school corporation do you live?

* If your child would attend public school what county is this school located?

Mailing Address: The mailing address of the parent/guardian of the child, not the address of the child's public school.

* Address

* City

State

* Zip

Zip+4

Phone Number: The phone number of the parent/guardian of the child, not the phone number of the child's public school.

* Phone

Participating Students in Each Grade Level (PK, KG, 1 to 12)

* Student Information

First Name	Last Name	Middle Name	STN (Optional)	Current Grade	Date of Birth