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Printing T:FORMS5000500-9995539E.FRP - Dadeschools.net 2026

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The document is a request form for enrollment in the Homebound/Hospitalized Instructional Program provided by Miami-Dade County Public Schools. It outlines the necessary steps for parents or legal guardians to authorize their child's participation, including obtaining a recommendation from a physician or psychiatrist. The form requires personal and medical information, as well as consent for the release of medical details to the school. It emphasizes that incomplete forms will be returned and specifies eligibility criteria for students to qualify for the program.

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Click ‘Get Form’ to open it in the editor.
Begin by filling out Section I, which requires the student's name, number, birth date, and address. Ensure all details are accurate for proper identification.
Next, provide the parent or legal guardian's information including their name and contact numbers. This section is crucial for communication regarding the student's enrollment.
In Section II, the physician or psychiatrist must complete their details including name, specialty, and expected date of return. This information is vital for assessing eligibility.
Ensure that all eligibility questions are answered with a 'yes' and initialed by the physician. This confirms that the student meets the necessary criteria for enrollment.
Finally, review all sections for completeness before submitting. Incomplete forms will be returned, so double-check your entries.

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2020	4.8 Satisfied (150 Votes)
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