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Homebound Instruction Claim Form - 504 (General Education)
Teachers who are identified as a homebound instructor for a general education student should complete this form. Please complete a form for each session of instruction.
Choose your school below.
This is the school where you work, not necessarily where you are tutoring. If you are in more than one building choose the building where your paychecks were previously delivered. Please choose "other" if you are not a G-C teacher.
J.B. Stephens Elementary
Greenfield Central Jr High School
Greenfield-Central High School
Name of student
Date of session
Example: February 8, 2016
Length of session in hours
Provide a brief summary of the instruction session below.
Type in the location of the instruction session below.
Example: Hancock County Public Library, Student's home, etc...
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This form was created inside of Greenfield-Central Community School Corporation.