Private School Affidavit (previously known as the R-4) Form Instructions
| Following is a line-by-line description of the online private school affidavit form, which you can find at http://www.cde.ca.gov/sp/ps/rq/affidavit.asp. We've included some helpful hints in filling out the form. We encourage you to approach all dealings with the California Department of Education with a business-like attitude. The form begins by asking you a few questions numbered 1-4 and asking whether you understand certain aspects of the law. You have to check each box to indicate your understanding and agreement to continue. These include your understanding that:
You then proceed to the questions for the affidavit itself. 5. You're asked to affirm the statement that "This is... a private full-time... school... [that]... offer[s] instruction in the several branches of study required to be taught in public schools of the state,... [ that offers this] instruction... in English [, and that keeps]... attendance [records]..." This feature is new in the 2006-2007 school year, but doesn't change anything. Only schools that can affirm this should be filing anyway. 6. Is this is a new school - We recommend that anyone who is starting a private school for the first time, or anyone who has been teaching their children independently but who has not filed the affidavit before, check "Yes". Those who have filed before can check "No". 7. Have you submitted an application or renewal for certification as a nonpublic, nonsectarian school (NPS) to the Special Education Division of the California Department of Education? This is new in the 2006-2007 school year. We believe it may have something to do with schools that seek certification so that they can offer special education and receive public funds for doing so. The usual answer would be "No." Anyone with a child needing special services who is interested in this needs to consult with their own counsel as to whether it is appropriate and/or available to them. 8. County - Select the county where your school is located from a drop down menu. 9. Public school district in which school is located - It is necessary to list the public school district in which your private school is located. Choose from the drop down menu after selecting your county. 10. CDS Code- If your school had previously been assigned a CDS code (usually only given to schools with six or more students), enter it. 11. Name of School - Enter the name you have chosen for your school. Any name you choose is permissible, although you may wish to use a name that is business-like and professional. "Cutesy" names may draw attention or unwarranted scrutiny to your school. This name should be used on all correspondence concerning the school. We strongly recommend that you either purchase printed letterhead and envelopes or prepare letterhead on your computer for you to use in correspondence on school matters. You need not worry about trademark issues or whether your name is unique unless you plan to operate it as a business; seek competent legal advice if you do. 12. Street Address - California law requires you to provide a street address in California (as opposed to a P.O. box) where your school conducts business. For most people, this will be your home address, and we recommend that you use that. If there is some reason why you feel you can't use your home address (e.g. you have concerns about personal security, or you travel extensively), please contact the HSC legal team. It might be better, in such a case, for you to join a private satellite program instead of forming your own school. 13. City - See above. 14. Mailing Address (if different from street address given in 11 and 12) - Enter mailing street address, including trying to find your "street" or "way" or "court" from a drop down menu. 15. Mailing City - See 14 above. 16. School Telephone Number - A phone number is necessary for your school. If you use an answering machine, consider changing your outgoing message to be appropriate for both family and school use. 17. Site Administrator - You must list a site administrator. This can be the same person as the School Staff (teacher) or the Director/Principal Officer. 18. Site Administrator Title - You're asked to pick a title for the site administrator, such as Principal, Headmaster, Headmistress, from a drop down menu. There's not a lot of importance as to which you choose. 19. School E-mail Address - The CDE uses the e-mail to send you a confirmation of your filing. As the CDE no longer requires you to submit a physical copy of the affidavit, this e-mail confirmation replaces the signed post office receipt as confirmation of your submission. When you provide an e-mail address, you might want to see if your internet service provider allows you to create a new account that has your school name in it (for example, LearningAcademy@yahoo.com), as this looks more professional than many typical family e-mail addresses (like momofgreatkids@yahoo.com). 20. Optional E-mail Address - Enter an additional e-mail address to receive communications if you wish. 21. Type of School - Choose one from the choices given: coeducational (you offer to teach both boys and girls), boys only, girls only or special education. We suggest, even if one of your children has learning issues or had an IEP when in public school, that you not check the Special Education box, as we believe that you may receive contact from the state about your services, etc. 22. School Accommodations - Even though your children sleep there, mark "Day Only." Residential Boarding Schools have complex requirements. 23. Grades Offered - You are to select, from a drop down menu, the lowest and highest grades OFFERED by your school, not the grades actually attended by your children. Do not offer kindergarten; regulations for kindergartens are more detailed than those for private elementary and secondary schools and marking this box will open you up to additional bureaucratic regulation. Since kindergarten is not compulsory, it is not necessary to offer it even if you have age-appropriate children. For example: You may choose to offer grades 1 - 12 or grades 1 - 6 even if you only have one child in the 3rd grade. 24. High School Diploma Offered - If you offer secondary education (grades 7 - 12), it is advisable to check "yes". There is nothing in the California statutes that prevents a home-based private school from issuing a diploma. 25. Former name of school - If your school filed under a different name last year, fill in this box. 26. Former public school district - Mark "none" unless the public school district in which your school site is located has changed since last year. 27. Classification of school - Choose either "Non-Religious" or "Religious." If you choose "Religious," you have to pick the religion from a drop down menu. We recommend you choose non-religious even if religion is important to you. Many church affiliates must meet additional requirements imposed by their churches. 28. Range of students' ages - You may enter the age range for the students actually attending, or the age range of students to whom education is offered. Do not include preschool or kindergarten age children in this range, for the reasons given above. 29. Enrollment on a single date - You should mark the boxes that correspond to your students' grade levels or you can check "ungraded elementary" or ungraded secondary." Do not mark any kindergarten age children in the kindergarten box for the reasons given above, and do not mark any children who are formally enrolled in another legal school, such as a public charter school. The system will automatically fill in 0s for the other grades. We generally recommend that, if you choose to use grade levels, you use the grade levels that match your children's chronological ages, even if they are doing work above or below their traditional grade level. We doubt that what you put in the affidavit would be controlling for any other purpose. For instance, if you were later to enroll your child in public school, they may or may not agree with you if you think a grade level other than the traditional one is appropriate, and the fact that you had listed your child as two grade levels ahead on your affidavit would have no importance to them. Some people also worry that if their child wants to take the CHSPE but isn't yet of 10th grade age, they will be prevented from doing so if they haven't marked someone at at least 10th grade level on the affidavit. Again, we doubt that this is an issue. Number of Twelfth Grade Graduates in the [prior] School Year - Mark number of students who graduated. 30. Number of School Staff - Count each person only once. Even if you are philosophically opposed to "teaching" your child "full-time," you should fill in one full-time teacher. Remember, you are establishing a full-time day school. For example: If you are both the teacher and the administrator, mark "1" under "Full-time teacher" and leave administrator blank. 31 - 40. Directors and Principal Officers - They want the names of at least one and up to two persons who serve as principal officer. Only one principal officer is required; it is fine to leave the section for the second officer blank. This can be the same person as the "Site Administrator." Again, an email address is optional. 41. Tax Status - Unless you have formed a corporation and been granted a federal tax exemption, you must select "none of the above." 42. NDSL Cancellation - Your school will not be eligible for NDSL loan cancellation status, so select "No." 43 - 46. Custodian of Records - Provide the name and street address of the person maintaining your records. This can be, but does not have to be, the same address as the physical school address you entered earlier. For most people, this will be your name and your home address. If, for any reason you have entered a place other than your home address as your school address (e.g. people who are reluctant to use their home address due to personal security concerns, or who were traveling extensively), make sure that the address you put here is for someone who actually maintains your records. This can be a relative, a friend, your accountant, whomever. But it has to be someone explicitly willing to take on that job, and at least a copy of the records should be kept at that address. All persons operating private schools must maintain attendance records, records of courses of study offered, and the names, addresses and qualifications of the faculty, even those of you who are using a correspondence school that maintains grades and records. Again, an email address is optional. 47 - 51. Acknowledgements - You are asked to check a series of boxes indicating that you understand that:
Electronic Signature - The CDE is no longer requiring that you mail in a signed copy of the affidavit. They used to ask for this because, by signing personally, you were making a statement under penalty of perjury. If it turned out you were lying, you could be held in contempt of court and subjected to penalties. They evidently believe that an electronic signature now has the same legal force and effect as one in pen and ink, so they are only asking for your name and some other personal identifying information. Before you hit the "submit form" button, we recommend you do two things. First, carefully check all the fields for accuracy. Second, we recommend that you try to print the form so that you have a record of what you submitted even if something goes wrong after that. Once you've done all that, click on "submit form." A confirmation page with a unique confirmation number will come up displaying the data. First, write the confirmation number down on a piece of paper. If something goes wrong with printing or your internet connection, at least you'll have the number that the CDE can use to find you in the system. Then print at least one copy of the confirmation page to keep at your school site with your records. If this page successfully printed with all of the information in the form before you hit the "submit form" button, you can get rid of the earlier form; the one with your confirmation number is the one that proves you filed the affidavit. This is the page that attendance officers are entitled to see if they come to your home asking about whether your child is enrolled in a legal school. It is also the page that you can give, for instance, to bookstores to try to get teacher discounts. Schools using the CDE's online filing system will have met their obligation to file a private school affidavit only when the data have successfully been submitted online; if the filing never makes it to the page where you get a confirmation number, you'll need to try again. Schools using paper affidavits, whether the form provided by the CDE or one they made up containing the statutorily required information, will be in compliance with 33190 only when they have mailed their affidavits to the CDE. If you're mailing your affidavit, we recommend that you mail it by certified mail, return receipt requested. This is powerful proof that your affidavit was received, and is worth every penny. Use a cover letter on your letterhead that sounds official. For example: "Enclosed for filing on behalf of [name of school] is the confirmation copy of the private school affidavit for the 2006-2007 school year. If you have any questions, please do not hesitate to call the undersigned at the above number" will work fine. Finally, and most importantly, keep in mind that, whether you are filing online with an electronic signature or filing a paper copy, you are signing the affidavit under penalty of perjury. Perjury is a criminal offense. Take it seriously. |

