HH Application 1A* Form 1A, pages 1 and treatment plan, page 2
The Homebound Application is:
  1. given to a parent/guardian by the school counselor.
  2. The parent/guardian fills out Parent Section and the student’s doctor completes and signs the Physician Section and then completes the Treatment Plan that prints out with Form 1A.
  3. All are returned to the school counselor in order for the administration to complete the application process. The more information about the student the school has, the better informed decision can be made concerning the need for homebound services.
Homebound Rules Form 1B After the parent/guardian returns the two-page doctor homebound application and rules form to the student’s home school, and the decision is made to enroll the student in the Homebound Program, the school 504 Coordinator completes an IAP on a student who doesn’t already have one in effect. Then the counselor completes HH Form 2 & 3 and sends all completed forms to the Homebound Office.


Homebound Application Form 2 – The school counselor completes HH Form 2 (Hospital/Homebound Intake Form 2) with recommendations for Homebound services signed by the principal and counselor.


Homebound Application Form 3 – The school counselor completes the indicated top portion of Form 3, fills in the schedule area or attaches a printed schedule, and obtains the principal’s signature of approval. This and all previously completed forms are faxed to the Homebound Office at 226-3630 for further action and teacher assignment by the homebound supervisor.


IAP – Complete an IAP for regular education students enrolled in the Homebound Program who do not already have an IAP in effect.


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EBRPSS, Hospital/Homebound Program, James Newman, Supervisor, PH (225) 929-8692 FAX (225) 929-8775
H/H Program Office: Choctaw Admin Center, Room 29,  2875 Michelli Drive, BR, LA 70805, PH (225) 226-3661, FAX (225) 226-3630  Contact Us