Supervisory Association for Educators in HERALD 5

(SAFE in H5)

Membership Application

2008-2009

__________________________________ ______________________________

Last Name First Name

__________________________________ _______________________________

Last Name Spouse’s First Name

__________________________________ __________________ ______ _________

Street Address City State Zip Code

_____________________ _________________ _____________________________

Home Phone Number Work Phone Number Email Address

 

SCHOOL DISTRICT: (District in which your child would attend school)

____Lexington/Richland 5 ____Lexington 2 ____Lexington 4 ____Richland 1 ____Fairfield

____Lexington 1 ____Lexington 3 ____Newberry ____ Richland 2 ____Other

PLEASE INDICATE YOUR HERALD FIVE SMALL GROUP_________________

MEMBER INFORMATION: Please list members from lowest to highest grade level. Choose one grade per child. If your child is between grades, choose the grade (s)he would attend in public school.

 

LAST NAME FIRST NAME GRADE

1._______________________________________ ________________________ ___________

2._______________________________________ ________________________ ___________

3._______________________________________ ________________________ ___________

4._______________________________________ ________________________ ___________

5._______________________________________ ________________________ ___________

6._______________________________________ ________________________ ___________

7._______________________________________ ________________________ ___________

**Any parent whose child is under the age of six years prior to 9/1/08 may elect for their child to waive attendance in kindergarten. The parent must sign a waiver with their school district or their supervisory organization (such as SAFE).

 

HERALD 5 SUPPORT GROUP STATUS: Membership in SAFE is contingent upon active HERALD 5 Support Group Status. Active membership requirements were outlined on your HERALD 5 application. Membership in SAFE will be denied those who do not meet those requirements.

 

SAFE in H5 Statement of Commitment

I commit to do the following:

  1. Maintain a current membership with Home School Legal Defense Association (HSLDA).
  2. Be an active member of HERALD 5 Support Group.
  3. Have a high school diploma or GED.
  4. Have an instructional year of at least 180 days.
  5. Plan a curriculum including, but not limited to, the basic instructional areas of reading, writing, mathematics, science and social studies; and in grades seven through twelve, composition and literature.
  6. Maintain educational records including:
  1. A plan book, diary, or other written record indicating subjects taught and activities in which the student and parent/teacher engage.
  2. A portfolio of samples of the student’s academic work.
  3. Semester progress reports including attendance records and grades/evaluations for each of the subject areas outlined in Point 5 above.
  1. Maintain active membership with SAFE in H5 by:
  1. Completing enrollment requirements by 8/15/08 (See below)
  2. Submitting the 90 and 180-day cards by assigned deadlines.
  1. Renew HSLDA membership before expiration of current membership and submit a copy of the new HSLDA card within 10 days of the previous card’s expiration date.
  2. Submit all requested forms/paperwork required by SAFE within 10 days of notification.
  3. Make records available upon request.

I understand that failure to fulfill any one of these commitments will result in termination of my child(ren)’s membership in SAFE in HERALD 5.

________________________________ _________________________

Principle Instructor Date

TO ENROLL SEND THE FOLLOWING TO SAFE :

___ A complete membership application

___ A signed Statement of Commitment (above)

___ A complete Course of Study for EACH member (make additional copies as necessary)

___ A copy of current HSLDA card (You will need to send another copy of your new updated card if your card expires during the school year.)

___ $5.00 for each member/student. (Checks should be made payable to SAFE in H5. Membership fees cover one academic school year. Applications and fees must be postmarked by 8/15/08.)

___ A signed copy of the SAFE cover letter indicating your understanding of and commitment to following the principles/requirements stated therein.

I have completed all of the above listed items. _______________________ _______

Signature Date

Mail to: SAFE in H5, PO Box 1743, Irmo, SC 29063

Registration deadline is August 15, 2008