School Year: _______________
Child's Name
Age / Grade
Supervisor Name
Tracking method (check one):   ☐ Hours (900 hours required for K–6 / 990 for 7–12)   ☐ Days (180 school days required)
PA Required Subject Hours Days Methods / Evidence
English (Reading, Writing, Spelling)e.g., Read-alouds, narration, journaling, dictated stories, phonics play
Arithmetic / Mathematicse.g., Life math, cooking fractions, Montessori materials, measurement projects
Sciencee.g., Nature journal, science walks, kitchen experiments, animal care
Geographye.g., Map drawing, family travel study, Waldorf geography block
History of the US & Pennsylvaniae.g., Historical fiction, PA history stories, co-op medieval unit, biographies
Civicse.g., Community service, co-op governance, current events discussions
Health & Physiologye.g., Nervous system lessons, nutrition, body awareness, sleep science
Physical Educatione.g., Daily outdoor play, hiking, swimming, yoga, dance, sports
Musice.g., Waldorf singing, instrument exploration, rhythm games, concerts
Arte.g., Watercolor, drawing, clay, Waldorf main lesson book, craft projects
Safety Education (incl. fire prevention)e.g., Fire safety drills, kitchen safety, road safety, first aid basics
TOTAL _____ / 900 _____ / 180 Fill in only the column matching your tracking method
Supervisor Statement: I, the undersigned supervisor, certify that the above home education program is being conducted in accordance with Pennsylvania Act 169 (24 P.S. § 13-1327.1), that instruction is being provided in the required subjects for the required time, and that each child is demonstrating sustained progress in the overall program. This record was maintained contemporaneously throughout the school year.
Supervisor Signature: ___________________________
Date: ___________________
Print one copy per child. Portfolio kept at home — only the evaluator's certification letter is submitted to the district. · The Wellspring Academy · PA Act 169