Procedures for Setting up a Homebound/Hospital Program

A Hospital/Homebouncl Program requires good communication, cooperation, and collaboration between the school, parents and the tutor
1) Convene a meeting to document the reason the program is needed:

Identify a district contact person (Case Manager) who will be responsible for managing the HHB program Student will be absent more than 10 consecutive school days Obtain a medical certificate authorizing the reason and anticipated length (attached) Complete Home/Hospital Instruction Request Form Identify goals to be accomplished as a result of providing the
program

Determine maximum number of hours per week (usually 5-10 depending on age and ability to work on academic tasks)
Secure parent consent (and releases if needed)

Complete a FACTS sheet and send to LADSE, to the attention of

Carrie Cervenka

2) Determine who will provide the tutoring (or related services)

If LADSE, call Lynn Krai to secure a tutor If district person, contact with conference record or IEP Set up communication plan between home-tutor-school

3) Prepare staff for return of the student

Work should be corrected by the tutor, but graded by the teacher Consider any necessary accommodations (shortened day, accessibility
issues, required medication or side effects) Make sure teachers are aware of student's return date

Complete FACTS sheet to indicate the end of the service

4) Parent Responsibilities An adult must be present at all times when the tutor is in the home It is the responsibility of the parent to make sure the home address is

visible and the home is accessible (clear sidewalk of snow, ice, etc.) Contact the tutor in a timely manner if student is unavailable for
tutoring

Please call Lynn Krai at LADSE, 708.354.5730, if you have any questions

Parent Responsibilities for

Homebound Tutoring Program

An adult must be present at aN times when the tutor is in

the home

It is the responsibility of the parent to make sure the home address is visible and entrance to the home is safely
accessible (clear sidewalk of snow, ice, etc.)

Please provide a smoke-free environment for our LADSE

tutors

$ *

Have school books and supplies ready when tutor arrives Secure any pets; provide a safe and quiet work area, in order to promote an environment free of distraction

Contact the tutor in a timely manner if student is unavailable for tutoring

Please contact Lynn Krai at LADSE, 708.354.5730 if you have any questions.

LAGRANGE AREA DEPARTMENT OF SPECIAL EDUCATION

1301 West Cossitt Avenue

LaGrange, IL 60525
MEDICAL REFERRAL

STUDENT NAME
SCHOOL
SERVICES RECOMMENDED:

AGE/GRADE.
DISTRICT

Home Tutoring

Hospital Tutoring

Approximate length of time pupil will need special services:.

Diagnosis:

Relevant History (positive physical findings, surgery, etc.)

Special precautions, suggestions, or instructions:

Date of last examination:

Parents home phone number:

Parents emergency number:_

Physician Signature.
Physician Address_

Physician Phone

LADSE
1301 W.Cossitt LaGrange, IL 60525

The LaGrange Area Department of Special Education

Dr.Sheri Wernsing
Executive Director

Phone: 708354.5730 Fax:708-354.0733 TTY: 708.352.5994

www.ladse.org

Home/Hospital Instruction Request Form

Student's Name:.
Address:

Birth Date:

City:

Zip:.

Parent(s)/Guardian
Name:
Home Phone: Work Phone:

Resident District:

Resident School:
Phone:

Grade:

School Contact Person:.

Nature of Illness:

Hours per week* (2 hrs. prep time for every 5 hours tutored):
Approved by:

Start Date:
Please check one:

Planned Stop Date:

Regular Education:
Additional Information:

/ Special Education:

* 5 hours a week (1 hour a day) ore standard

Supporting education for ail children in the community school districts:

>3
61 62

Butler
Darien Gower

94 Komarek
95 8rookfield-LaGrangePark 96 Riverside
101 Western Springs

102 LaGrange
105 Lyons 105 LaGrange South 106 LaGrange Highlands

107

Pleasantdale

86 Hinsdale Township High School 204 Lyons Township High School

208 Riverside Brookfield Hiqh School

92': Westchester