School Recommendation Form (page 2): Completely fill out the top portion (including the date the parent submitted all forms with the parents’initials) and answer all questions on the lower portion of the school’s statement.
Student Instructional Information (page 3): Check one of the teaching formats (face to face or online). Attach the current IEP or 504 Plan*
Fill out the current courses/classes the student is enrolled in and circle the applicable assessment(s) including the dates of upcoming assessments that pertain to the student.
The school’s homebound liaison/administrator/designee will sign and date the application and then email or fax the entire application to the homebound office with the homebound cover page no later than 48 hours after the application has been submitted by the parent. Only when ALL portions are complete can this application be submitted to the homebound office.
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.
Students with IEP’s:
If a student with an IEP is in need of homebound 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 firstname.lastname@example.org with the date, time and location. Homebound services cannot begin until signed consent is granted.
If there are any questions please contact Madelyn Swing at email@example.com , 757-628-3950 ext. 21254 or by fax 757-628-3825 Attn: Madelyn Swing