23/24 SHUFSD Homebound Instruction Timesheet

Timesheets must be submitted at the end of each month. You can submit up to 5 sessions per sheet. Please make sure your timesheet is complete and submit for only one subject per form. Note if it was In Person (IP) and the location or Virtual (V). If there is any missing or incomplete information, the timesheet will not be processed and will delay payment.

Homebound Instructor's Information:

First and Last Name: *

SHUFSD Email: *

ID# *

Student's Information:

First Name: *

Last Name: *

Grade: *

Student's TOR * 🛈

Subject: *

Building: *

Session Information:

Complete for Each Session Below: 🛈

	Date (MM/DD/YY)	Start & End Time	IP/V/Location	# Hours
1	Date (MM/DD/YY)	Start & End Time	IP/V/Location	# Hours
2	Date (MM/DD/YY)	Start & End Time	IP/V/Location	# Hours
3	Date (MM/DD/YY)	Start & End Time	IP/V/Location	# Hours
4	Date (MM/DD/YY)	Start & End Time	IP/V/Location	# Hours
5	Date (MM/DD/YY)	Start & End Time	IP/V/Location	# Hours

Session Notes/Topic Covered/Location of sessions (list by each session) *

Number of hours requesting: * 🛈

Click Calculate To Total:

0.00

I certify that the services were provided on the dates indicated in accordance with the Homebound Instruction Handbook. *

Yes

No

Homebound Instructor's Signature: *

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