• Please read:

    All homebound applications have to be renewed each school year. If there is a new need for homebound services or if the need continues, a new application can be submitted no more than 30 days prior to the first day of school.

    Applications that are not completed within 3 days (parent portion, school portion and medical portion with the correct doctor’s signature) will receive a notice indicating the application cannot be processed and they will have to resubmit their application to the Homebound Office.

    • If your child has a mental health condition a signature is needed from the treating doctor’s office where there is a licensed psychiatrist or psychologist.
    • If your child has a physical condition the treating doctor’s signature is needed on the homebound form.
    • If you child has both a mental health condition and a physical medical condition you will need both doctors signature

    Students with IEP’s:

    If a student with an IEP is in need of homebound/homebased services, the application must be approved before an IEP meeting is held. Once approved, you will be notified by the homebound office to schedule the IEP meeting. Once the meeting is scheduled contact the homebound office via email at mswing@nps.k12.va.us with the date, time and location. Homebound services cannot begin until signed consent is granted.

    Homebound services medical extenstion request:

    Following the initial application approval, the Medical Certification of Need, Physician Extension Request is required if more time is needed after the nine weeks. This must be completed and submitted no more than 30 days maximum and 2 weeks minimum of the current expiration date or no later than 5 school days after the current expiration date. If neither of the required deadlines are met, the parent must restart the homebound process and a new homebound application will be required.

      

    Homebound Required Forms:

     

    Page 1- Parent/Guardian/Adult Student (18 & up) Section: (Part I) 

    Please complete all information on the parent section of the application (page 1) including an email address if available. Then sign and date the form.

    If the packet is not submitted with all forms completed (parent portion, school portion and medical portion), you will have 3 business days to complete the submission. After 3 business days a new homebound application must be submitted. 

    Pages 2-3 - Medical Certification of Need: (Part II)

    This form is to be completed and signed by a licensed physician or a licensed clinical psychiatrist/psychologist, including their current license number. All questions on this form have to be completed.

    • If your child has a mental health condition a signature is needed from the treating doctor’s office where there is a licensed psychiatrist or psychologist
    • IF your child has a physical condition the treating doctor’s signature is needed on the homebound form. 
    • If you child has both a mental health condition and a physical medical condition you will need both doctors signatures

    Pages 4-5 School Recommendation For Homebound Services: (Part III)

    This form must be completed by your child’s school of attendance and submitted with the other portions of the homebound application.

    • The school’s homebound liaison/administrator/designee will sign and date the application and then submit to the homebound office no later than 24 hours after the application has been completed by the parent. 
    • Applications that are not completed within 3 days (parent portion, school portion and medical portion with the correct doctor’s signature) will receive a notice indicating the application cannot be processed and they will have to resubmit their application to the Homebound Office. 
    • Once the parent and medical forms are complete, please return them to your child’s school and the homebound liaison/administrator/designee from the school will complete the school’s portion. Only when all portions are complete can this application be submitted to the homebound office.

     If there are any questions please contact Madelyn Swing at mswing@nps.k12.va.us , 757-628-3950 ext. 21254 or by fax 757-628-3825 Attn: Madelyn Swing