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AUDIT NEWPORT NEWS / SOURCE RECORD
March instructional billing record
REDACTED PUBLICATION COPY | REVIEWED OCTOBER 27, 2026
Source p. 1 of a four-page supplied packet. The form covers March 1-23 and is submitted April 1, 2026. Student, school/grade
identifiers and the teacher ink signature are removed. Blank responsible-adult and parent-certification fields remain visible.
NEWPORT NEWS PUBLIC SCHOOLS INSTRUCTIONAL SERVICES
TIME SHEET FOR HOMEBOUND/ HOME BASED INSTRUCTION
Return form to Homebound Office. All information must be completed and submitted by the Stn of each month,
except for December. Form needs to be submitted by December 1s.
fy ZBAS
Period of Hom:
Student's Na
Homebound Teacher's Name
To be used for billable hours only. Please only include hours you conducted and waiting times (up to 45
minutes) for missed sessions.
Date of Beginning | Ending | Hours Taught | Comments Responsible Adult's | Date of
Instruction | Time Time Signature Signature
B/E § 13/5 F =
3/4 Z/5_ | 5/5 =
C/O 7 =
3, 2/5 |S 3 =
Z 2/5 | 3/5 3 =
Ze} 2/5, | YA Ex —
3//¢ 2/5. LZ 3 =
Bh TOMES ES =
3/20 | 2/5 | Ws za =
Teacher Signature: wes... submitted: 4 Vhs ko
|, parent/guardian of certify that the above hours are correct to the
best of my knowledge.
Parent/guardian signature: Date:
Nine rows dated March 2-20 total 24 billed hours (3+3+2 hours in each of three weeks). Billing and a signature/date do not
independently audit delivered instruction. This copy is not authenticated as the attachment referenced in the April 21 accounting
email
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