Students that may need homebound services should request the required forms or packet from the school counselor’s office or for the Public Schools of Robeson County website. The names of the sequential forms are below and the signatures that are necessary on specific forms for processing are listed in parenthesis. Please note that it is the parents’ or guardians’ responsibility to make certain that the necessary signatures are obtained. Please contact the school counselor or a homebound teacher if clarification or assistance is needed.

1. School Request Form

a. School Request for Homebound Services (Principal/Counselor) b. Doctor Request for Homebound Services (Parents) [a, b, and c are on first form] c. Central Office Approved/Denied Form (Homebound Teacher) d. Parental Guidelines (Homebound Teacher and Parent) e. Authorization to Use or Disclose Information (Parent and Medical Doctor)


2. Homebound Student Assignments ( Teachers and/or Counselor)

3. Doctor’s Release Form (Parents)

4. Homebound Release Form (Homebound teacher )