This form is to be completed by the designated person and return to

Homebound

Every Child . . . Every Day . . . Whatever it Takes ! ! !

4515 Eddie Williams Ave.
Alexandria, Louisiana 71302
318.443.4572
Fax: 318.473.0356

Supervisor: Alice McBride
318.443.4572

This form is to be completed by the designated person and returned to the supervisor.
Application for Homebound Instruction pdf.
Application Cover Letter pdf.

Two copies of the criteria for Eligibility Form are required.

You are to keep one copy.
Give one copy to the referring physician.

Notice of Homebound Eligibility will be sent to you upon receipt of the referral form, which has been completed by your physician.