Consideration for Homebound Services
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Dear Parent/Guardian,
To request a consideration for homebound services for a student who is unable to attend school for at least 20 days due to a physical, medical, or mental health condition, complete this form along with a release of information to your child’s treating physician.
Please submit these forms to intervention services at intervention@sd27j.net or fax to 303-655-2831.
The school nurse will contact the treating physician to get more information regarding your student’s current needs related to homebound vs attending school. Once that has occurred, you will be contacted about next steps.
If you have any questions about this application, please call 303-655-2900 and ask for the Intervention Services department.
The purpose of homebound instruction is to maintain continuity in the educational process for those students who cannot attend school for an extended period of time due to an illness or other medical condition. In each instance, the student’s health care provider must provide documentation of the need and estimate of the probable length of time the student will be unable to attend school and the length of time s/he is capable of receiving home instruction. The school nurse will contact the medical provider to gather this information. Homebound necessity will be reviewed every 45 days to ensure that students are not out of the school setting any longer than necessary.
Request to Release or Secure Confidential Information
This permission shall be valid for the following duration:
Indicate Consent for Records/Information to be Released or Secured:
Parental Consent:
I understand that consent is voluntary and may be revoked at any time in writing. I hereby authorize the transfer of information as indicated above.