Rev. 7/2016

Student Attendance/Participation Agreement

for Hospital Homebound(HHB) Services

(Please check each box below.)

I, ______, understand that I am eligible to receive services based on a medical condition or other documented reason that keeps me from attending school. AlthoughI may receive services in my home, I am still responsible for my education in the following ways:

I am expected to participate in lessons and complete/submit work by the due date set by my teacher.

I will login/attend any set appointments with my teacher either by phone, web-conference, or face to face.

My family will contact my teacher(s) if I am unable to participate due to a medical condition documented on a medical report.

I will request missing assignments from my teacher(s) if I have been unable to participate in a lesson.

I understand that I am required to participate in State/District testing(Florida Standards Assessments [FSA], End of Course Exams [EOCs], etc.) and that my home school’s testing coordinator will work with me to schedule testing in the school or home prior to the State/District testing windows. Currently, computer-based tests are not available in the home and I will be provided a paper-based test if I am unable to come into the school setting. If I have any questions regarding testing schedule, I will contact my case manager.

I understand that the extended time accommodation for assignments is based on my individual situation and that this time does not extend beyond the end of the current semester. I will contact my teacher(s) or case manager if I have any questions about timelines/due dates/accommodations.

If I have a concern about my grade, I will contact my teacher(s) prior to the end of the semester. I understand that my grades will not be changed after this time and I will be assigned a grade that is an average of complete (grade%) and incomplete work (0%).

If absences are not directly related to my identified medical conditionon the medical report (headaches, colds, stomachache, etc,) I will follow the attendance guidelines in the Student Code of Conduct for making up missed work.

If HHB services are missed due to theidentified medical condition on the medical report, a medical excuse may be requested for verification. Only verified medical excused absences are required to be made up through compensatory instructional time.

I will schedule medical appointmentsand therapies, so that they will not interfere with my scheduled instruction.

I understand that if I miss five scheduled sessions with my teacher(s) or do not participate in the curriculum according to the establishedtimelines, an IEP meeting will be held to address my attendance and set clarify expectations.

I understand that if I do not adhere to this agreement, it may prevent the district from being able to implementing my IEP, which could result in dismissal/discontinuation from HHB.

Attendance, self-advocacy and family support are important to ensure success in the HHB program. Yoursignature below indicates that you understand the HHB attendance policy.

Student Signature / Print Student Name / Date
Parent Signature / Print Parent Name / Date