PUBLIC SCHOOLS (MCPS) CESC, Room 248, Rockville, Maryland MCPS Form 311-15B September 2019 Page 1 of 2 Note: This form is used by the Interim Instructional Services (IIS) Office to obtain a physician or certified nurse practitioner recommendation and parent/guardian permission to initiate instruction for students with a physical health condition. Return completed application to student s school counselor or principal/designee. For more information, see MCPS Regulation IOE-RB, Interim Instru.
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How to fill out the MD MCPS Form 311-15B online
This guide provides a detailed and user-friendly approach to filling out the MD MCPS Form 311-15B online. Designed for students with physical health conditions, the form facilitates the process of obtaining necessary instructional services with the appropriate recommendations and permissions.
Follow the steps to complete the form accurately online.
- Click ‘Get Form’ button to access the MD MCPS Form 311-15B and open it in the editor.
- Begin by filling out the student’s information in the first section. This includes the student’s name, MCPS ID number, grade, last day of school attendance, and the MCPS school attended.
- Next, enter the parent's or guardian’s information. Fill in their name, telephone numbers (home, work, and cell), email address, and relationship to the student. If there are two guardians, repeat the information for the second one.
- Indicate the times the child is available for instruction by checking the corresponding boxes for weekdays, evenings, or weekends.
- Authorize the Montgomery County Public Schools (MCPS) to consult with the physician or certified nurse practitioner by checking the authorization box. Sign and date the application as the parent or guardian.
- Move to the second section designated for the counselor/principal/designee. Fill out the information regarding the student's Individualized Education Program (IEP) or Section 504 Plan if applicable. Record the relevant dates for the application process.
- Ensure the school counselor or principal/designate signs and dates the application.
- Instruct the parent/guardian to have the licensed physician or certified nurse practitioner complete the second page of the form, including medical verification of the child's condition, and return the entire application to the school.
- Lastly, users can save the completed form, download, print, or share it as needed.
Complete your application online to ensure timely processing for Interim Instructional Services.
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