Referral Form

  • Click here to download form.

    For a Special Education student, a copy of the current IEP and/or NOREP must accompany the referral form and must state the need for homebound instruction and the length of time homebound instruction is needed.

    For any medical homebound requests, an orginal doctor's note must accompany the referral from. The note must state the diagnosis and reason for homebound instruction and the expected length of time that homebound instruction is needed. It must be signed and dated by the physician.

    It is the responsibility of the referring Principal to secure an instructor. Contact Melissa Stevens at 261-3420 for ideas if you are having trouble with this step.

    Please sign the second page of the referral and send it and the supporting documents to Melissa Stevens either by interoffice mail or email. Once the Director of Pupil Services has authorized instruction, the counselor, principal and teacher listed on the referral will be notified to start instruction.