Homebound: Referral Instructions

Eligibility and Instructions

A student is eligible for Homebound Instruction if he/she will be absent at least 2 weeks from school due to injuries, illnesses or emotional problems.  A referral form must be completed and returned to the school prior to the beginning of homebound instruction.  Referral forms are available from your child's school office.  A certified teacher will provide instruction for a minimum of 3 hours per week.

1. This form must be received by the Homebound teachers before the Homebound program can be initiated.
2. The top part of the form must be completed in full by the parent or guardian. Please see that the principal signs the form and that a copy of the student's schedule (if middle or high school) is attached to the form.
3. The bottom of the form must be signed by a medical doctor. A form will not be accepted if it is signed by a counselor or a physician's assistant.
4. Return the completed form to the student's counselor.