Fillable 2022-2023 Homebound Application
Print-Only 2022-2023 Homebound Application
Only when ALL portions of the homebound application are complete can the application be submitted to the homebound office. Incomplete applications will not be processed and will be returned to the school.
Components of the Homebound Application
- Parent/Guardian Section (1 page)
- Medical Certification (2 pages)
- School Recommendation (2 pages)
The parent completes components one and two above. Once Parent and Medical forms are complete, please return them to your child’s school and the homebound liaison will complete the school’s portion no later than 48 hours after the application has been submitted by the parent.
Completed homebound applications are to be submitted via email to: firstname.lastname@example.org
The application is only valid for 30 days from date of the doctor’s signature. Applications older than 30 days will be denied, and an updated medical portion will need to be completed.
Students with a Disability
If a student with a disability is found eligible for homebound services, you will be notified by the homebound office to schedule the Individualized Education Plan (IEP) meeting. Once notified, you will consult with the homebound specialist and parent to determine a date, time, and location for the IEP meeting. The homebound program specialist will attend ALL homebound IEP amendment meetings. Once the parent provides consent for homebound services, forward the signed amended IEP and Prior Written Notice (PWN) containing homebound services to the homebound office via email to email@example.com
If there are any questions, please contact Anna Frassmann-Swadinsky at firstname.lastname@example.org 757-628-3950 ext. 21107 or by fax 757-628-3825 Attn: Anna Frassmann-Swadinsky