About this Form
Form number: 311-15B
Audience: Parents/Guardians, School Staff
Last revised: October 2016
Form 311-15C - Application for Interim Instructional Services, with Qualified Mental Health Condition ONLY
Note: This form is used by the Interim Instructional Services (IIS) Office to obtain physician’s recommendation and parent’s permission to initiate instruction for students with a medical health condition. Return completed application to student’s school counselor or principal/designee.
A new completed application is required for continuation of service beyond 60 calendar days.
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