Here is a sample 504 Plan.
SCHOOL
NAME
Accommodation
Plan
Section 504 of the Rehabilitation
Act of 1973
Student: School
Year: 2019-2020
Conference
Date:
Grade:
Teacher:
|
Parents:
Address:
Phone:
|
Is there a
documented physical or mental impairment, which substantially limits a major
life activity?
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
Walking Thinking
Lifting Communicating
Bending Working
Other
None
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________________
|
No comments:
Post a Comment