California 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
Visual / Performing Arts	Units / Topics Covered	Grade / Progress
Physical Education	Units / Topics Covered	Grade / Progress

Curriculum Materials

List curriculum materials used by subject (free-form).

Days of Instruction

Annual instructional log — required by California private-school affidavit (Cal. Ed. Code §48222).

Month	Days Possible	Days Completed	Absences

Immunization & Proof of Progress

Immunization status or exemption:

Proof of progress method:

Parent Signature

Parent signature:

Printed name:

Date:

Filing Notes

Tier 3 — affidavit/portfolio tier. California families operating as a private school (Cal. Ed. Code §48222) file an annual Private School Affidavit (PSA) with the California Department of Education, track instructional days, and demonstrate academic progress either through a standardized test, a portfolio review, or an Annual Review with a Certificated Teacher (ARC). Source: California Department of Education homeschool/PSA guidance.