Instructions for Completing DOE Form 4140

Instructions for Completing DOE Form 4140!

§302A-1132 Attendance Compulsory; exceptions

(a) Unless excluded from school or excepted from attendance, all children who will have arrived at the age of at

least five years on or before July 31 of the school year, and who will not have arrived at the age of eighteen

years, by January 1 of any school year, shall attend either a public or private school for, and during, the school

year, and any parent, guardian, or other person having the responsibility for, or care of, a child whose

attendance at school is obligatory shall send the child to either a public or private school. Attendance at a

public or private school shall not be compulsory in the following cases:

(1) Where the child is physically or mentally unable to attend school (deafness and blindness excepted), of

which fact the certificate of a duly licensed physician shall be sufficient evidence;

(2) Where the child, who has reached the fifteenth anniversary of birth, is suitably employed and has been

excused from school attendance by the superintendent or the superintendent’s authorized representative, or

by a family court judge;

(3) Where, upon investigation by the family court, it has been shown that for any other reason the child may

properly remain away from school;

(4) Where the child has graduated from high school;

(5) Where the child is enrolled in an appropriate alternative educational program as approved by the

superintendent or the superintendent’s authorized representative in accordance with the plans and policies

of the department, or notification of intent to home school has been submitted to the principal of the public

school that the child would otherwise be required to attend in accordance with department rules adopted to

achieve this result; or

(6) Where:

(A) The child has attained the age of sixteen years;

(B) The principal has determined that:

(i) The child has engaged in behavior which is disruptive to other students, teachers, or staff; or

(ii) The child’s non-attendance is chronic and has become a significant factor that hinders the

child’s learning; and

and the child’s parent, guardian, or other adult having legal responsibility for or care of the child,

develops an alternative educational plan for the child. The alternative educational plan shall include a

process that shall permit the child to resume school.

The principal of the child’s school shall file the plan made pursuant to subparagraph (C) with the

child’s school record. If the adult having legal responsibility for or care of the child disagrees with the

plan, then the adult shall be responsible for obtaining appropriate educational services for the child.

(b) Any employer who employs a child who is excused from school attendance in accordance with subsection

(a)(2) shall notify the child’s school within three days upon termination of the child’s employment. [L 1996,

c89, pt of §2 and am c 162, §2]

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Instructions for Completing DOE Form 4140!

§8-12-5 Procedures for exceptions due to disabilities.

(a) A parent whose child is physically or mentally unable to attend school, deafness and blindness excepted, shall

complete and submit Form 4140, Exceptions to Compulsory Education, to the local public school.

(b) A parent, whose child is physically or mentally unable to attend school, deafness and blindness excepted, shall

also submit sufficient evidence of the identified disabilities to the local public school. A certificate from a duly

licensed physician shall be sufficient evidence.

(d) Requests for exceptions due to identified disabilities shall be renewed annually. [Eff. 11/7/91; am and comp

5/13/00] (Auth: HRS §§302A-1112, 302A-1132) (Imp: HRS §302A-1132)

§8-12-6 Procedures for exceptions due to employment

(a) A parent whose child has reached the fifteenth anniversary of birth and is suitably and lawfully employed shall

complete and submit Form 4140, Exceptions to Compulsory Education, to the local public school for the

principal’s recommendation as to whether the exception should be granted. The form shall then be submitted t

e district superintendent for approval.

(b) A family court judge may also approve an exception due to employment.

week.

(d) The student’s employer shall notify the school within three days if employment is terminated. The student shall

return to the school unless the student provides the principal with verification of new employment.

(e) Requests for exception due to employment shall be renewed annually. [Eff. 11/7/91; am and comp 5/13/00]

(Auth: HRS §§302A-1112, 302A-1132) (Imp: HRS §302A-1132)

§8-12-7 Procedures for exceptions due to family court order.

(a) Approval for exceptions due to family court order shall be authorized by a family court judge.

(b) The approval of the family court judge shall be obtained on Form 4140, Exceptions to Compulsory Education,

and submitted to the local public school.

and comp 5/13/00] (Auth: HRS §§302-A-1112, 302A-1132) (Imp: HRS §302A-1132)

§8-12-8 Procedures for exceptions for alternative educational programs, other than home schooling.

(a) The parent of a child requesting a compulsory attendance exception for an alternative educational program other

than home schooling shall complete and submit Form 4140, Exceptions to Compulsory Education, to the local

public school.

(b) For purposes of this chapter, enrollment in a private school’s home study school program shall not be construed

as equivalent to attendance at a private school.

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Instructions for Completing DOE Form 4140!

curriculum for the child along with the Form 4140. The curriculum shall be structured and based on

educational objectives as well as the needs of the child, be cumulative and sequential, provide a range of up-to-

date knowledge and needed skills, and take into account the interests, needs and abilities of the child. The

submittal shall include the following:

(1) The commencement date and ending date of the program;

(2) The number of hours per week the child will spend in instruction which shall average approximately three

hours per school day;

(3) The subject areas to be covered in the planned curriculum:

(A) An elementary school curriculum may include the areas of language arts, mathematics, social studies,

science, art, music, health and physical education to be offered at the appropriate development stage of

the child.

(B) A secondary school curriculum may include the subject areas of social studies, English, mathematics,

science, health, physical education and guidance.

(4) The method used to determine mastery of materials and subjects in the curriculum; and

(5) A list of textbooks or other instructional materials which will be used. The list shall be in standard

bibliographical format. For books, the author, title, publisher and date of publication shall be indicated.

For magazines the author, article title, magazine, date, volume number and page shall be indicated.

(d) The superintendent or the superintendent’s designee may approve withdrawal from school where an appropriate

educational program other than home schooling is developed for the child in accordance with the plans and

policies of the department.

(e) A request for an exception for an alternative educational program other than home schooling shall be renewed

annually.

(f) Further exceptions to the provisions of this chapter [chapter 8-12] concerning a child’s alternative educational

program may be granted by the superintendent upon the written request of the parent and the recommendations

of the principal and the district superintendent. [Eff. 11/7/91; am and comp 5/13/00] (Auth: HRS §§302A-

1112, 302A-1132) (Imp: HRS §302A-1132)

Form 4140 Homeschooling Instruction

Notification of Intent to Home School

1. All parents choosing to home school their children must notify the local public school principal by:

a. Completing Form DOE 4140 (Rev. 8/23), Exceptions to Compulsory Education (Top portion with

student information: name, student ID number, birth date, telephone number, address, school, complex

area, grade; Section A name of parent/guardian, signature and date; and Section B indicating with an

“X” “Homeschooling” and inserting the date); or

b. Submitting a letter with a statement of intent to home school the child(ren) and containing the

following information:

• Name, address, and telephone number of the child;

• Birth date and grade level of the child; and

• Signature of the parent and date of signature.

2. The school and district office acknowledge the notice of intent submitted by the parents by:

a. Sending the parents a copy of Form DOE 4140 after it is signed by the principal and complex area

superintendent. (Principal and complex area superintendent check “Acknowledged” and not

“Approval Recommended” or “Approval Not Recommended); or

b. Writing “Acknowledged:” on the bottom of the parent’s letter of notification with the date and

signature of the principal and complex area superintendent, and returning the letter to the parent.

Copies of the letter should be kept on file at the school and district office.

3. The notice of intent to home school a child is for record keeping purposes and to protect families from

unfounded accusations of educational neglect or truancy. The principal and the complex area superintendent

are acknowledging receipt and not granting permission.

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Instructions for Completing DOE Form 4140!

4. As long as parents are complying with the annual progress monitoring requirement (§8-12-18(b)), they do not

have to resubmit the notification of intent to home school their child on an annual basis. However, another

notification of intent must be submitted when the child is transferring from one local public school to another

for example, transition from the culminating fifth or sixth grade in elementary school to sixth or seventh grade

at middle or an intermediate school, or moving from district to district. Parents should also contact the school if

they are moving out of state so that their child(ren)’s name(s) can be removed from the state home school roster.

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DOE Form 4140, Rev. 8/23

Student

STUDENT I.D. No.

Birth Date

Age

Last

First

Middle

Telephone Number Address

Street City Zip

School Complex Area Grade

A. I hereby request that the above named child be withdrawn from school for the school year in

accordance with HRS §302A-1132.

Father/Guardian

(print or type name)

Signature

Date

Mother/Guardian

(print or type name)

Signature

Date

B. Indicate with a checkmark in the column the reason for withdrawal. Choose one (1) option.

1) Disability, 2) Employment, 3) Family Court Order 4) Alternative Education, 5) Homeschooling

1) EXCEPTIONS DUE TO DISABILITIES

Attach certificate of duly licensed physician.

2) EXCEPTIONS DUE TO EMPLOYMENT

After age 15. Attach verification of minor’s employment status.

3) EXCEPTIONS PURSUANT TO FAMILY COURT ORDER

Attach court order.

Phone

4) EXCEPTIONS FOR ALTERNATIVE EDUCATION

Attach professional staff qualifications and child’s instructional program.

Program Name and Address

Approval required for above reasons.

(Signed Form 4140 Form original sent to parents and copy filed at the school of record)

Principal

Complex Area Superintendent

Approval Recommended

Approval Not Recommended

Approval Recommended

Approval Not Recommended

Signature

Date

Acknowledgment required for homeschooling.

(Signed Form 4140 original sent t

o parents and copy filed at the school of record)

Principal

Complex Area Superintendent

Acknowledged

Signature

Date

State of Hawaii

DEPARTMENT OF EDUCATION

P.O. Box 2360

Honolulu, Hawaii 96804

EXCEPTIONS TO

COMPULSORY

EDUCATION

Acknowledged with reservations

_____

_____ Acknowledged with reservations

5) HOHOMMEESSCHOCHOOOLLIINGNG The abovhe above ne named child will be

homeschooled ffrromom:

(

FOR HIGH SCHOOL'S OFFICIAL USE ONLY

Submitted by (Counselor's Name) : _________________________ Phone:____________________ High School Code: __________