Pennsylvania Homeschool Report Card Template

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Student & School Year

School year:

Grade level:

Student name:

Date of birth:

Parent / Guardian:

Address:

Subjects & Progress

Subject	Units / Topics Covered	Grade / Progress
English / Language Arts	Units / Topics Covered	Grade / Progress
Mathematics	Units / Topics Covered	Grade / Progress
Science / Health	Units / Topics Covered	Grade / Progress
Social Studies	Units / Topics Covered	Grade / Progress
Fine Arts / Physical Education	Units / Topics Covered	Grade / Progress

Days of Instruction

180 days / 900 hours per school year (24 P.S. §13-1327.1)

Month	Days Possible	Days Completed	Absences

Standardized Test Scores

Required in grades 3, 5, and 8.

Grade	Test Name	Score	Date
Grade 3	Test Name	Score	Date
Grade 5	Test Name	Score	Date
Grade 8	Test Name	Score	Date

Qualified Evaluator

Evaluator name:

Qualifications:

Evaluation date:

Evaluator signature:

Parent Signature

Parent signature:

Printed name:

Date:

Filing Notes

Tier 3 — approval/curriculum submission tier. Families must submit a notarized affidavit to the local school district before the start of each school year, provide a portfolio for annual review by a qualified evaluator, and submit standardized test results in grades 3, 5, and 8. Source: 24 P.S. §13-1327.1.