Forms

As of July 1, 2013 Laws changed. The following is for families filing Form A under CPI Option 1 (Supervising Teacher) and those opting in to file CPI Option 2 (Assessment).

Families should submit Form A to the district of residence for each child by September 1, or within 14 days of removing the child from school, or within 14 days of moving into the district.

If a child requires special education services, the Director of Special Education at the AEA must pre-approve CPI for the child.

If filing Form A for the 1st time, attach immunization information. Proof of immunization is required of all children receiving CPI, including those enrolled in a HSAP unless the immunization exemption form is also completed for religious or medical reasons.

Form A

Certificate of Exemption for Immunizations (Medical/Religous Reasons)

In 2007 Legislation was enacted Iowa General Assembly requires all children under the age of 6 to have a blood lead test. Compliance with this requirement will be verified for children enrolling in kindergarten and children under the age of 6 for whom a Competent Private Instruction report form is filed. This will be done by matching the names of these children with the Iowa Department of Health’s blood lead database.

Certificate of Exemption for Blood Lead Test (Religious Reasons)

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