HOME EDUCATION WRITTEN EVALUATION FORM
There are five options for fulfilling the requirement for an annual evaluation. Selecting a teacher holding a valid regular
Florida certificate to review and discuss the contents of the required portfolio with the student is an option that is used
frequently.
STUDENT INFORMATION
___________________________
Student Name
________________________________ ______________________________
Date of Birth Grade 2009-2010 School Year
_____________________________
Street Address
______________________________ _______________________________
City, State Zip Name of Parent/Guardian
STATEMENT FROM FLORIDA CERTIFIED TEACHER:
Upon review of the portfolio and discussion with the pupil named above, I certify that the pupil has demonstrated
progress at a level commensurate with his/her ability. I understand Florida law requires that I hold a valid regular
Florida certificate in elementary education or in an academic subject at the secondary level. My signature attests to my
qualification.
____________________________________ _______________________________
Janice K. Zeiger Evaluation Date
816960
Certification Number
June 30, 2014
Certificate Expiration Date