Tuesday, February 25, 2020

What does a 504 Plan look like?

Here is a sample 504 Plan. 

Accommodation Plan
Section 504 of the Rehabilitation Act of 1973

Student:                                               School Year:   2019-2020

Conference Date: 



Is there a documented physical or mental impairment, which substantially limits a major life activity?
              Yes            No      

Is this student qualified under IDEA?             Yes            No      

Does this student require accommodations designed to meet his/her needs as adequately as the needs of non-handicapped students?     Yes            No      

Nature of Disability:

Data Sources Used for making 504 decision:

Check the major life activities that are substantially limited by the physical or mental impairment:
 Caring for oneself                           Speaking
 Performing manual tasks                Breathing                                      
 Hearing                                           Learning
 Eating                                             Reading
 Sleeping                                          Concentrating
 Walking                                          Thinking
 Lifting                                            Communicating
 Bending                                          Working
Description of how disability affects major life activity:

People responsible for accommodations:

Describe the appropriate placement:

How will the accommodations address the effects of the physical or mental impairment?

Accommodations for the Student:

Review/Reassessment Date: 

Participants Names                                         Title:

Parent Signature_____________________________________Date________________

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