Homebound Staff Resources

The resources on this page are intended for use by SSD staff and employees in SSD's partner school districts.

If you are a family member seeking information about obtaining homebound services for a student, please contact Karen Whelan at kswhelan@ssdmo.org or 314.989.8383, or Kari Farless at krinkus@ssdmo.org or 314.989.8433.

Homebound Application

The application is a five-part PDF document that can be downloaded and saved to your computer, filled out and submitted electronically. Repeating fields on Parts 3-5 will be auto-filled if you complete the document on your computer.

Submit the application and supporting documents electronically by attaching them to an email to homebound@ssdmo.org or faxing to 314.989.8425.

Homebound Application

application.pdf 1.53 MB (Last Modified on May 11, 2020)

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Application Directions

application_directions.pdf 139.81 KB (Last Modified on May 11, 2020)

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Quick Start Card

quick_start.pdf 178.82 KB (Last Modified on May 11, 2020)

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Parent Letter & Sign-Off Form

Digitally signable version of the Parent Letter and Sign-Off Form (Parts 2-3). You may email this document, have it digitally signed and then email it to homebound@ssdmo.org.

parent_letter.pdf 152.75 KB (Last Modified on May 11, 2020)

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Parent Release & Physician's Authorization Form

May also be printed and provided to parents individually. Per SSD Board of Education policy, the physician's signature must be an original.

release_authorization.pdf 118.06 KB (Last Modified on May 11, 2020)

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Medical Extension Request

If medical homebound services need to be extended, the school needs to complete a plan for transitioning the student back to school-based services in Part 12 of this document, and the physician needs to complete and sign Section 13.

medical_extension.pdf 123.42 KB (Last Modified on May 11, 2020)

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