Free School 504 Form in PDF

Free School 504 Form in PDF

The School 504 form is a critical document designed by The School District of Palm Beach County Department of Adult and Community Education. It outlines a Section 504 School Site Accommodation Plan, establishing the groundwork necessary for students with disabilities to access educational programs and services. To learn more about how to ensure that every student's needs are addressed, click the button below to start filling out the form.

Get Form

The School District of Palm Beach County has developed the Section 504 School Site Accommodation Plan, an essential document designed to support students with physical or mental impairments that significantly impact major life activities. This form serves as a cornerstone for ensuring that eligible students receive the necessary accommodations and services to participate fully in their educational experiences. It begins by identifying whether a student has an impairment that substantially limits a major life activity, followed by verification of the disability on file to establish Section 504 eligibility. Crucially, it outlines whether the student's disability necessitates instructional accommodations or related aids and services, detailing specific needs and the accommodations or strategies that may be implemented. These can range from instructional support, assistive technology, test-taking strategies, to behavioral contracts, among others, tailored to each student's unique requirements. By involving all stakeholders through required signatures from students, LEA representatives, instructors, and parents or guardians where applicable, the plan formalizes a collaborative approach to facilitating students' educational success. As such, this form is a pivotal tool in the commitment of the School District of Palm Beach County to inclusivity and equal access to education for all students.

Preview - School 504 Form

THE SCHOOL DISTRICT OF PALM BEACH COUNTY

DEPARTMENT OF ADULT AND COMMUNITY EDUCATION

Section 504 School Site Accommodation Plan

Name:

 

 

 

 

 

 

Date:

 

Student ID#:

 

 

Date of Birth:

 

 

School:

 

 

 

 

Program:

 

 

 

 

 

Instructor:

 

 

 

 

Yes

No

1. Does the student have a physical or mental impairment which substantially limits a major

 

 

 

 

life activity? If YES, describe the limitation(s).

 

 

 

 

 

Yes

No

2. Is written verification of the disability on file? If YES to questions 1 and 2, student meets

 

Section 504 eligibility criteria.

Yes

No

3. Does the student's disability require any instructional accommodations and/or related

 

aids and services in order for the student to benefit from his/her educational experience?

The student's specific needs are:

The following accommodations/strategies may be implemented to meet the student's needs:

 

Instructional

 

Assistive Technology con't

 

Support Services

 

 

Oral reading of text

 

 

Calculator

 

 

Interpreter (hearing impaired/deaf)

 

 

Alternative text (taped,

 

 

Headphones

 

 

Note taker

 

 

large print, Braille)

 

 

Furniture adaptations

 

 

Peer buddy

 

 

 

 

 

 

 

 

 

Video, etc.

 

 

Computer devices/software

 

 

Volunteer/mentor

 

 

Tutoring

 

 

Closed captioning

 

 

Other

 

 

Study skills

 

 

Other

 

 

 

 

 

 

Test taking strategies

 

 

 

 

Miscellaneous

 

 

Flexible setting

 

Testing

 

 

State exam assistance

 

 

Preferential seating

 

 

Flexible scheduling

 

 

Agency referral

 

 

Extended program time

 

 

Oral testing

 

 

Counseling

 

 

Other

 

 

Additional time

 

 

Behavior/attendance contract

 

 

 

 

 

Reader

 

 

Time Management

 

Assistive Technology

 

 

Audio version

 

 

Other

 

 

Tape recorder

 

 

Revised format

 

 

 

 

 

 

Electronic speller

 

 

Flexible response recording

 

 

 

 

 

 

Magnifier

 

 

Other

 

 

 

 

 

Other accommodations/strategies:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Signatures of Plan Participants:

Signature of Student

 

 

Date

 

 

Signature of LEA Representative

Date

 

 

 

 

 

 

 

 

 

Signature of Instructor

 

 

Date

 

 

Signature of Parent/Guardian (if applicable)

Date

 

 

 

 

 

 

 

 

 

Signature of Data Processor

 

 

Date

 

 

 

 

 

PBSD 2405 (New: 1/15/2014)

ORIGINAL - ESE Folder

COPY - Fax to Department of Adult and Community Ed 561-649-6028

Document Specs

Fact Name Description
Form Identification The form is identified as PBSD 2405, a creation of The School District of Palm Beach County Department of Adult and Community Education for Section 504 School Site Accommodation Plan.
Purpose This form is used to determine whether a student with a physical or mental impairment that substantially limits a major life activity is eligible for accommodations under Section 504 of the Rehabilitation Act of 1973.
Eligibility Criteria A student must have a physical or mental impairment which substantially limits one or more major life activities, and verification of this disability must be on file, to meet Section 504 eligibility criteria.
Accommodations and Aids The form lists possible instructional accommodations, assistive technology, support services, and strategies that can be implemented to address the student's specific needs.
Assessment It assesses the need for instructional accommodations and related aids/services for the student to benefit from the educational experience.
Documentation The form acts as official documentation of the accommodation plan agreed upon for the student, requiring signatures from the student (if applicable), the LEA representative, the instructor, the parent/guardian, and the data processor.
Distribution After completion, an original copy is kept in the ESE folder, and a copy is faxed to the Department of Adult and Community Education.

Instructions on Writing School 504

After gathering the necessary information and documentation for a student who may qualify for accommodations under Section 504 of the Rehabilitation Act, the next step is to complete the School 504 form. This formal documentation will serve as the foundation for any accommodations or modifications in the student's educational plan, ensuring they receive the support they need. Completing the form accurately is critical to expedite the accommodation process.

Steps for Filling Out the School 504 Form:

  1. Start by entering the student's full name, the date the form is being filled out, the student's ID number, date of birth, school, and the specific program they are enrolled in.
  2. Enter the instructor's name who is directly involved with the student's education.
  3. Address the first question regarding whether the student has a physical or mental impairment that substantially limits a major life activity. If "Yes," provide a detailed description of the limitation(s) in the space provided.
  4. For the second question, indicate whether written verification of the student's disability is on file. A "Yes" response is required for the student to meet the Section 504 eligibility criteria.
  5. The third question asks whether the student's disability necessitates instructional accommodations and/or related aids and services for them to benefit from their educational experience. If "Yes," specify the student's specific needs.
  6. Choose and detail the accommodations, strategies, and/or assistive technology that may be implemented to meet the student's needs, using the options provided under instructional, assistive technology, support services, test taking strategies, and other accommodations/strategies. Add any additional information that is pertinent to the student's needs.
  7. At the bottom of the form, ensure that all required signatures are obtained and dated, including the student's, LEA (Local Educational Agency) representative's, instructor's, parent/guardian's (if applicable), and data processor's signatures.
  8. Upon completion, retain the original form in the student's ESE (Exceptional Student Education) folder, and send a copy via fax to the Department of Adult and Community Education at the number provided on the form.

By carefully following these steps, students who require accommodations will be better supported in their educational journey, creating a more inclusive and accessible learning environment for everyone. Make sure to review the form for accuracy and completeness before submission to ensure a smooth and efficient process.

Understanding School 504

What is a School 504 Plan?

A School 504 Plan is a plan developed in educational settings under Section 504 of the Rehabilitation Act of 1973. It's designed to provide support and accommodations to students with disabilities, ensuring they have equal access to education. These accommodations may include adjustments in the learning environment, instructional strategies, or utilization of assistive technology, tailored to the student's individual needs.

Who is eligible for a School 504 Plan?

Eligibility for a School 504 Plan is determined based on whether a student has a physical or mental impairment that substantially limits one or more major life activities. If verified documentation of such a disability is on file and the disability necessitates instructional accommodations for the student to benefit from their education, the student qualifies for a 504 Plan.

How is a disability defined under Section 504?

A disability, as defined under Section 504, refers to any physical or mental impairment that substantially restricts one or more major life activities. This can include, but is not limited to, conditions like ADHD, learning disabilities, mobility impairments, and chronic health issues that interfere with daily functioning.

What types of accommodations are available under a 504 Plan?

The accommodations under a 504 Plan can vary widely, tailored to the student's needs. Examples include preferential seating, extended time for tests, modified assignments, the use of assistive technology, and adjustments to the classroom environment or teaching methods. The aim is to remove barriers to learning caused by the disability.

How is a School 504 Plan developed?

The development of a School 504 Plan is a collaborative process involving educators, parents or guardians, and often the student. The team assesses the student's needs and determines the appropriate accommodations. The plan is documented and includes specific strategies and aids to be used, as well as roles and responsibilities of those involved.

Is written verification of a disability required for a 504 Plan?

Yes, to qualify for a 504 Plan, there must be written verification of the student's disability on file. This documentation can come from various sources, including medical providers, psychological evaluations, or other professional assessments that clearly verify the disability and its impact on the student's learning.

What happens if a student's needs change?

A 504 Plan is a living document, meaning it should be regularly reviewed and updated as needed. If a student's needs change, the plan participants, including educators and parents or guardians, can meet to revise the accommodations and strategies to ensure they continue to support the student's education effectively.

Are schools required to comply with a 504 Plan?

Yes, under Section 504 of the Rehabilitation Act of 1973, schools receiving federal funding are required to comply with established 504 Plans. Failure to adhere to the accommodations and supports outlined in the plan can be considered a violation of a student's rights.

How does a 504 Plan differ from an IEP?

A 504 Plan and an Individualized Education Program (IEP) both aim to support students with disabilities, but there are key differences. A 504 Plan provides accommodations based on a student's disability to ensure access to education. In contrast, an IEP, provided under the Individuals with Disabilities Education Act (IDEA), offers more comprehensive services and supports, including individualized instruction and possibly related services, designed for students who qualify for special education.

Who should I contact if I believe my child needs a 504 Plan?

If you believe your child may be eligible for a 504 Plan, the first step is to contact your child's school. Schools will typically have a 504 coordinator or a similar point of contact who can guide you through the process of requesting an evaluation and developing a plan if your child is eligible.

Common mistakes

One common mistake made when filling out the School 504 form is overlooking the requirement to provide written verification of the disability. It is essential to have documentation on file as this is a critical step in establishing eligibility under Section 504. Without this, the process may be delayed or the application might not be considered valid.

Another error is failing to accurately describe how the physical or mental impairment substantially limits a major life activity. It's important to provide specific details rather than general statements to ensure that the plan meets the student's unique needs.

Some individuals mistakenly believe that answering "Yes" to the questions regarding impairment and verification automatically means accommodations will be awarded. However, the form also requires a detailed account of the student's specific needs and how these relate to their disability, which is often overlooked.

A frequent oversight is not fully considering the range of instructional accommodations, assistive technologies, or support services available. By not exploring all options, one might miss out on beneficial accommodations that could significantly enhance the educational experience.

Often, the section for listing specific accommodations or strategies is filled out with vague or generic terms. The effectiveness of the 504 Plan hinges on clear, precise, and customized strategies tailored to the student's situation, which requires thoughtful consideration and planning.

Ignoring the importance of collaborative input is another misstep. The form includes spaces for signatures from various stakeholders, including the student, parent/guardian, instructor, and LEA representative. Each party's input and agreement are crucial for the plan's success, yet sometimes not all parties are adequately consulted.

Forgetting to date the signatures is a simple but significant error. Dates are essential for tracking the plan's implementation and for future reviews or updates. Without dates, it's difficult to ensure timely follow-up or reassessment.

Another mistake is not considering the need for updates to the form. As students grow and change, their needs may also evolve. Failing to revisit and revise the plan as necessary can result in accommodations that are no longer appropriate or effective.

Some people do not make use of the "Other" sections to specify accommodations or strategies that are not listed but might be highly relevant to the student’s success. This oversight can lead to missing out on unique or innovative supports that could make a substantial difference.

Last, there is often a failure to send a copy of the completed form to the Department of Adult and Community Education, as required. This step is vital for the record-keeping process and ensures that the student receives proper support across different platforms within the educational system.

Documents used along the form

Ensuring students with disabilities receive appropriate education tailored to their individual needs is pivotal. The School 504 plan, designed to offer accommodations, is just one tool among many that can help achieve this goal. To craft a comprehensive support strategy, various other documents often complement the School 504 form, each serving a unique purpose in safeguarding the educational rights and meeting the needs of students with disabilities.

  • Individualized Education Program (IEP): A detailed document, mandated for students in special education under the Individuals with Disabilities Education Act (IDEA), outlining specific educational goals, services, and accommodations for a child.
  • Medical Documentation: Reports or letters from healthcare providers that diagnose a student's condition and detail its impact on learning. This documentation supports the need for accommodations outlined in a 504 plan.
  • Teacher Observations: Written accounts by educators documenting the student's performance and behavior in the classroom setting, often including observations on how the disability affects learning.
  • Psychoeducational Evaluation Reports: Comprehensive assessments conducted by psychologists or other professionals to determine a student's cognitive abilities, learning styles, and emotional or behavioral needs.
  • Behavior Intervention Plan (BIP): A plan that identifies problematic behaviors linked to the student’s disability, proposes strategies and interventions to address these behaviors, and monitors their effectiveness.
  • Functional Behavioral Assessment (FBA): An evaluation process used to understand the purpose or cause of specific behaviors before creating a BIP. It helps in identifying the relationship between the environment and the behavior.
  • Accommodation Modification Plan: A document that details any changes in teaching methods, classroom environment, or educational requirements, including adjustments in how a student learns and demonstrates knowledge.
  • Emergency Health Care Plan: For students with health-related disabilities, this plan provides instructions for managing health emergencies (e.g., allergies, seizures) at school, ensuring a rapid and effective response.

Together, these documents form a network of support around students with disabilities, ensuring their educational experience is both accessible and effective. The collaborative efforts of educators, healthcare providers, and parents, guided by these documents, are essential in creating an inclusive environment where every student has the opportunity to succeed.

Similar forms

The Individual Education Plan (IEP) shares similarities with the School 504 form, as both are designed to ensure students with disabilities receive appropriate accommodations in their educational environment. The IEP, however, is more specific to students receiving special education services under the Individuals with Disabilities Education Act (IDEA), focusing on tailored educational goals and objectives, alongside the accommodations similar to those outlined in a 504 Plan.

An Americans with Disabilities Act (ADA) accommodation request form is another document akin to the School 504 form. Both instruments are guided by federal laws aimed at preventing discrimination against individuals with disabilities. While the ADA form is used in a variety of settings, including employment and public accommodations, the School 504 form is specific to educational contexts, ensuring students have the necessary accommodations to access their education fully.

The Health Care Plan for students with medical needs is somewhat parallel to the School 504 form in its purpose of outlining accommodations or services for students. However, it uniquely focuses on the medical and health-related accommodations necessary for students with health conditions to safely attend school, sometimes including emergency action steps, unlike the broader focus of the School 504 form which encompasses various types of disabilities.

The Job Accommodation Network (JAN) Accommodation and Compliance Series forms are used by employers to determine reasonable accommodations for employees with disabilities, similar to how the School 504 form identifies educational accommodations for students. Although serving different populations, both types of documents aim to facilitate the success of individuals by mitigating barriers posed by disabilities.

College Disability Services Accommodation forms provide accommodations for students with disabilities in higher education, much like the School 504 form does at the K-12 level. These college forms ensure that students have equal access to educational opportunities, including modifications to coursework, testing accommodations, and other supports needed to navigate the academic environment.

An Employee Health and Wellness Program accommodation request form, while primarily aimed at workplace adjustments for employee health and well-being, shares the goal of providing necessary adjustments for individuals with disabilities, similar to the objective of the School 504 form. Although one is used in employment and the other in an educational setting, both seek to identify and implement accommodations or modifications that support the individual’s success.

A Special Education State Complaint form is utilized when individuals believe there has been a violation in the provision of services to students with disabilities, which could include issues related to 504 plans. While this form functions as a tool for reporting and investigating complaints, it intersects with the School 504 form’s mission of ensuring students' rights are upheld in educational settings.

The Patient Request for Medical Accommodation form used in healthcare settings also aims to ensure individuals with disabilities receive necessary accommodations, mirroring the purpose of the School 504 form. Though one is utilized in educational contexts and the other in healthcare, both documents facilitate access to essential services and support for people with disabilities.

Last, the Accessibility Feedback Form, commonly used by organizations to receive input on the accessibility of their services or environment, indirectly supports the objectives of the School 504 form. By gathering feedback, organizations can make informed decisions about necessary accommodations or modifications, much like how the School 504 form outlines specific supports for students to ensure their full participation in education.

Dos and Don'ts

When filling out the School 504 Plan, it's important to focus on accuracy and thoroughness to ensure the student gets the necessary support. Here’s a guide to help navigate the process:

  • Do gather all required documentation about the student's disability before starting the form. This includes assessments, diagnosis information, and letters from healthcare providers.
  • Don't rush through the form. Take your time to accurately describe how the student's disability affects their learning and daily school activities.
  • Do be specific about the limitations and the necessary accommodations. The clearer you are, the easier it is for the school to provide the right support.
  • Don't forget to check if there's a need for instructional accommodations or related aids and services. This ensures the student receives a comprehensive support system.
  • Do consult with the student's teachers, special education staff, and if possible, the student, to identify which accommodations will be most effective.
  • Don't overlook the importance of including contact information for follow-up. It's vital for the school to reach out if they need further clarification.
  • Do review the form for accuracy and completeness before submitting. Mistakes or omissions can delay the provision of support.
  • Don't submit the form without making a copy for your records. It's essential to have a personal copy for future reference or if issues arise.

By following these guidelines, the process of filling out the School 504 Plan can be smooth and effective, ensuring that students receive the support they need to succeed in their educational environment.

Misconceptions

Misconceptions about the School 504 Plan often arise due to misunderstandings about its purpose and implementation. Here are five common myths, along with explanations to help clarify these points.

  • Only students with physical disabilities qualify.

    This is a misconception as Section 504 covers any qualifying disability, physical or mental, that substantially limits one or more major life activities. This includes conditions such as ADHD, learning disabilities, and anxiety, as well as physical disabilities.

  • 504 Plans are only for academic accommodations.

    While academic support is a significant component, 504 Plans can also provide for non-academic needs, including extracurricular activities, transportation, and health services, ensuring that students have equal access to all aspects of school.

  • A doctor's note is always required to get a 504 Plan.

    While medical documentation can support a request for a 504 Plan, it is not always required. Schools can also consider evaluations from qualified school professionals and information provided by the parent or guardian.

  • 504 Plans provide less support than Individualized Education Programs (IEPs).

    This isn't necessarily true. While IEPs and 504 Plans are designed for different purposes and needs, a 504 Plan can offer accommodations that are just as impactful for a student. The key is that the accommodations under a 504 Plan should allow the student to equally access education in comparison to their peers.

  • After being approved for a 504 Plan, the accommodations are permanent.

    Accommodations under a 504 Plan are subject to review and can be adjusted depending on the student's changing needs. Schools are required to periodically reassess the plan to ensure it continues to provide appropriate support.

Understanding these misconceptions can lead to a better appreciation of how 504 Plans are designed to support students with disabilities in the educational environment, ensuring they have access to the same opportunities as their peers.

Key takeaways

Understanding the School 504 Plan is crucial for parents, educators, and students to ensure that every student with a disability has the opportunity to receive an appropriate education. Here are five key takeaways about filling out and using the School 504 form:

  1. Eligibility Requirements: The form starts by assessing a student's eligibility for a 504 Plan. A student must have a physical or mental impairment that substantially limits one or more major life activities. It's important to provide clear documentation of the disability to meet the eligibility criteria.

  2. Documentation Is Key: For a student to qualify for accommodations under Section 504, written verification of the disability must be on file. This documentation often includes medical records or evaluations from qualified professionals. Without this, the process cannot move forward.

  3. Specific Accommodations: The form requires a detailed account of the student's specific needs and the accommodations or strategies that might be employed to address these needs. This could include instructional support, assistive technology, or changes to the testing environment. It highlights the necessity for an individualized approach.

  4. Collaboration Is Essential: Completing the 504 Plan is a collaborative process involving signatures from the student (if applicable), a representative of the Local Education Agency (LEA), the instructor, the parent or guardian, and the data processor. This emphasizes the importance of agreement among all parties involved regarding the decided accommodations.

  5. Maintain Updated Copies: After all relevant signatures are gathered, the original document is to be kept in the student's Educational Service (ESE) folder, and a copy must be faxed to the Department of Adult and Community Education. Keeping updated copies in easily accessible places ensures that the student's accommodations are implemented consistently across all environments and by all personnel involved.

Properly filling out and using the School 504 form is a step toward creating an inclusive educational environment where every student is provided the tools they need to succeed, regardless of their disabilities. It not only outlines the specific requirements of the student but also legally ensures the provision of these necessities.

Please rate Free School 504 Form in PDF Form
5
(Exceptional)
2 Votes

Additional PDF Templates