How to fill out a private school affidavit (R-4) form

How to fill out a private school affidavit (R-4) form

Following is a line-by-line description of the online private school affidavit Form with some helpful hints in filling out the form

County – Enter the county where your school is located.

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 will not draw too much
attention and, perhaps, 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. Also, we recommend that you select a name that does not call undue attention to you.

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.

Street Address/City – It is necessary to provide the street address of your school site; a post office box is not sufficient.

Mailing Address/Mailing City – If you do not receive mail at your street address, provide your mailing address. Complete this section only if your mailing address is different from your site address.

Former Name of School (if any) – If your school filed under a different name in the past, fill in this box.

Example: During the 2000-2001 school year, you filed an affidavit under school name "A." During the 2001-2002 school year (last year), you filed an affidavit under school name "B" and filled in "Former School Name --- A". This year, 2002-2003, you will again file your affidavit under school name "B" and fill in "Former School Name --- A."

Site Administrator – You must list a site administrator. This can be the same person as the School Staff (teacher) and the Director/Principal Officer.

Title of Administrator – Give yourself an appropriate title.
Example: Principal, Headmaster, Headmistress, or (if your principal officer is a different person) Assistant Principal, Assistant Headmaster, etc.

Other Administrator/Title of Other Administrator – You may choose to leave this blank.

Type of School – Choose one: coeducational (you offer to
teach both boys and girls); boys only; or girls only.

School Accommodations – Even though your children
sleep there, mark "Day Only." Residential Boarding Schools
have complex requirements.

Grades Offered – This is for the grades OFFERED by
your school, not the grades actually attended by your
children. Do not offer kindergarten; regulations for
kindergartens 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. You should also
not say that you operate a preschool, because of strict
licensing and other regulations.

Example: You may choose to offer grades 1 – 12 or grades
1 – 6 even if you only have one child in the 3rd grade.

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.

Public school district in which school is located – It is
necessary to list the public school district in which your
private school is located.

Our district has changed – Mark "no" unless the public
school district in which your school site is located has
changed since last year.

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.

Enrollment on a single date – Mark the boxes that
correspond to your students’ grade levels. Do not mark any
kindergarten age children in the kindergarten box.

Example: If you have a 5 year old, a 7 year old and a 9 year
old (who is enrolled in a local public charter school) you will
place a "1" next to Grade 2 and leave the remaining grades
marked "0".

Number of Twelfth Grade Graduates in the 2001-2002
School Year – Mark number of students who graduated.

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.

Example: If you are both the teacher and the administrator,
mark "1" under "Full-time teacher" and leave administrator
blank.

NDSL Cancellation – Your school will not be eligible for
NDSL loan cancellation status, so check "no."

School has been granted – Unless you have formed a
corporation and been granted a federal tax exemption, you
have to mark "no tax exemption" here.

Classification of School – Choose either "secular" or
"religious school, not church affiliated." Many church
affiliates must meet additional requirements imposed by
their churches.

This school offers programs for children with the
following disabilities – Do not mark any of the "programs
for children with the following handicaps" even if your child
has a handicap. Checking any of these boxes may open you
up to special scrutiny or unwanted intrusions.

Directors/Principal Officers Names – This can be the
same person as the "Site Administrator." Only one principal
officer is required; it is fine to leave the section for the
second officer blank.

Position – If this is the same person as the "Site
Administrator", use the same title you used before (e.g.
assistant principal) if it is a different person, use a different
title (e.g. principal)

Street Address/City – Provide a street address for the
principal officer; this will probably be the same as your
school address.

Name of Individual who is Custodian of Records –
Provide your name and street address. Even if you are using a correspondence school that maintains grades and records, you must maintain attendance records, records of
courses of study, and the names, addresses and qualifications of the faculty.

Address/City – This will be the street address and not mailing address.

Before you hit the "submit form" button, carefully check all the fields for accuracy. When the Private School Affidavit is submitted online, a confirmation page will display the data. The page contains a place for signature to certify the information on the affidavit. Print two copies of the confirmation page. The owner or chief administrative officer must sign one copy and mail it to CDE. Keep the second copy at your school site
with your records.

Mail your confirmation copy 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. A simple "Enclosed for filing on behalf of [name of school] is the confirmation copy of the private school affidavit for the 2002-2003 school
year. If you have any questions, please do not hesitate to call the undersigned at the above number" will work fine. Many businesses, when filing important documents like this, send an extra copy with a stamped, addressed return envelope (again, look professional here); the letter has a line saying "Please file stamp the enclosed copy and return it to the
undersigned in the envelope provided".

Schools will have met their obligation to file a private school affidavit only when (a) the data have been submitted online and (b) the printed and signed confirmation page is returned to the CDE.

Finally, and most importantly, keep in mind that you are signing the affidavit under penalty of perjury. Perjury is a criminal offense. Take it seriously.

Article found at: http://www.hsc.org/chaos/legal/r4instructions.php