[Date]
[Director of student services or principal's name]
[School district]
[District address]
Re: Request for homebound instruction for [Student name], date of birth [Date of birth], grade 9, [School name]
Dear [Name]:
I am the treating child and adolescent psychiatrist for [Student name], a student in grade 9 at [School name]. The student is attending a treatment program during school hours. I am writing at the request of the student's parent or guardian to request homebound instruction for the period described below. The parent or guardian has signed a release permitting me to share this information with the district.
Certification
I certify that, in my medical judgment, the student is unable to attend school because of a health condition for which the student is under my care, and that instruction outside the school setting is necessary during this period. The family has chosen not to share the diagnosis, and the district does not need it to act on this request; the certification above is what the district's procedure calls for. I expect the student to be unable to attend for six to eight weeks, through approximately [date].
What the student can do
The student is able to manage core subjects at a reduced pace. Instruction should prioritize [core subjects] and defer the rest, with no penalty for the deferral. Instruction may be provided in person at home or by video, whichever the district can begin sooner. The following limits apply: sessions limited to one hour; sessions in the afternoon only, since mornings are taken by treatment. [Add the days and times the student is available.]
Request
- Approve homebound instruction beginning [Start date] and arrange the instructor and schedule within the district's usual timeline.
- Record the student's attendance as present for homebound instruction during this period, and excuse the days before instruction begins.
- Treat work completed under homebound instruction as fulfilling the requirements of the current courses, with incompletes rather than failing grades for anything that cannot be completed.
- Consider whether the student should be evaluated for a Section 504 plan, since a condition that prevents attendance substantially limits learning; I can provide a separate letter.
- Plan the return now: I will write separately when the student is ready, with a stepped schedule and the supports the first weeks back will need.
Instruction during treatment keeps the student connected to school and makes the return shorter and more likely to hold. I ask that the district begin it without waiting for the full period to be certain.
Sincerely,
[Your name]
[Credentials and role]
[Practice or hospital]
[Direct phone and fax]
Enclosures: [Signed release of information; the district's homebound instruction form, completed.]