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Get GA Declaration of Intent to Utilize a Home Study Program

__________ * Indicate by placing an “X” next to the name of any student who is identified as or suspected of needing special education services. Please note this section is optional. The school year for this home study program is a 12-month period from ___/___/___ to ___/___/___. I will notify the Georgia Department of Education if my address changes or if I discontinue the home study program. Signature of Parent/Guardian: ____________________________________ Date Submitted: ______________.

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