Forms Boundary School Administrator needs completed to begin Short/Long-Term H&H process:
Dr.'s Statement of Needs
Physician, Psychologist, or Licensed Clinical Social Worker verification stating the reason(s) for H&H services and the length of time recommended.
Parent/guardian and boundary school administrator completes the H&H Registration Form.
Short-Term Disclosure Statement
Facilitates understanding of the short-term H&H program.
Long-Term Disclosure Statement
Facilitates understanding of short/long-term H&H program.
District Mileage Report to be submitted monthly for each student on the program – be sure to list the address of the student served with the student’s name.
Monthly Teaching Record
Teacher records weekly visits to students including time with student, mileage, and any comments.
District timesheet to be submitted monthly – be sure to correspond the name of the student served with time charged.