Home Study Part-Time Enrollment Participation Declaration

Home Study Part-Time Enrollment Participation Declaration

Atlanta Public Schools
Atlanta Public Schools recognizes home study students will be afforded the opportunity to participate in extracurricular and interscholastic activities in the student’s resident public school system. In accordance with Senate Bill 42: “The Dexter Mosley” Act, a home school student may enroll in a qualifying course at his/her designated school within the attendance area of the student’s custodial parent’s primary residence and participate in extracurricular or interscholastic activities, subject to certain terms and conditions.

The following documents are required to submit this form:
- Home School Declaration of Intent
- A copy of the student’s most recent annual progress assessment report
- Written statement by the home study program instructor that verifies the student is currently receiving a passing grade in each home study course, is maintaining satisfactory progress toward advancement, and meets the requirements for participation in the specified activity
For more information on The Dexter Mosley Act, please click here.
School Year
Multilingual Programs + Services Translation Statement
Student's Legal Name*

First NameM.I.Last NameSuffix
Student's Date of Birth*

MonthDayYear
Public School of Residence*
Current Grade Level*
Permanent Address*

Street Address

Street Address Line 2

CityState

Zip Code
Parent/Guardian Name*

First NameLast Name
Parent/Guardian Phone Number*
Please enter a valid phone number.
Parent/Guardian Email*
example@example.com
Extracurricular/Interscholastic activities sought:*

BaseballBasketbalBasketballCompetitive CheerCompetitive CheerCross CountryCross CountryDance TeamDrill TeamFlag FootballFootballGolfLacrosseSoccerSoftballSwimmingTennisTrack/FieldVolleyballWrestlingOther
Please upload the following documents
Verification of home school enrollment (Copy of Declaration of Intent)*

Cancelof
A copy of the student’s most recent annual progress assessment report*

Please upload a copy of the home study student’s most recent annual progress report, with written verification by the home study program instructor that the student is currently receiving a passing grade in each home study program course, is maintaining satisfactory progress towards advancement, and meets the academic requirements for participation in the specified extracurricular or interscholastic activity.
Cancelof
Written statement by the home study program instructor that verifies the student is currently receiving a passing grade in each home study course, is maintaining satisfactory progress toward advancement, and meets the requirements for participation in the specified activity*

A current copy of the student’s transcript including the number of cumulative units earned to date
Cancelof
Enrollment Acknowledgement

By signing this form, I acknowledge the following:
- I understand my student must be registered, and this declaration and the information required prior to enrollment must be submitted to the school of residence 30 days prior to participation.
- I understand I must provide my student’s most recent annual progress report, with written verification by the home study program instructor that my student is currently receiving a passing grade in each home study program course, is maintaining satisfactory progress towards advancement and meets the academic requirements for participation.
- I understand my student must maintain enrollment in at least one qualifying course per semester to remain eligible for Extracurricular/ Interscholastic activities.
- I understand my student must adhere to attendance requirements as contained in the APS Student/Code of Conduct.
- I understand my student must meet the same age, academic, zoning and other rules and regulations and other eligibility requirements as apply to full-time public-school students (accumulated units, units passed previous semester, etc.) for participation in the specified extracurricular or interscholastic activity.
- I understand my student must follow the APS Student Code of Conduct.
- I understand a student who withdraws from APS to home school full-time will result in the loss of eligibility for one calendar year.
- I understand under this program my student is ineligible to graduate from APS.
Parent/Guardian Signature*

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Submission Date

MonthDayYear
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Home Study Part-Time Enrollment Participation Declaration

Please upload the following documents