Get the free 504 Referral Form - MHS - metuchenschools

MATCHES HIGH SCHOOL Guidance and School Counseling Department 400 Grove Avenue, Matches, NJ 08840 7323218750 SECTION 504 REFERRAL FORM Student Name: Age: Birthdate: School: Grade/Teacher: Person Making

How to fill out 504 referral form

Steps for filling out a 504 referral form:

1. Gather the necessary information: Begin by collecting all relevant documentation and information needed to complete the referral form. This may include the student's personal details, medical records, academic history, and any existing accommodations or modifications.
2. Identify the purpose: Understand the purpose of the 504 referral form, which is to initiate the evaluation process for a student who may require accommodations or support under Section 504 of the Rehabilitation Act. This law prohibits discrimination against individuals with disabilities in public schools and other federally funded institutions.
3. Fill out the student's details: Start by providing the student's full name, date of birth, grade level, and school. Ensure that all fields requiring personal information are accurate and up to date.
4. Specify the reasons for the referral: Clearly state the reasons why the student is being referred for a 504 evaluation. This could be due to a physical or mental impairment that substantially limits one or more major life activities, which may impact the student's educational performance or participation.
5. Provide supporting documentation: Attach any relevant documentation, such as medical reports, evaluations, or assessments that support the need for a 504 evaluation. These documents should clearly demonstrate the student's disability and its impact on their education.
6. Include input from relevant individuals: Seek input from individuals who have knowledge of the student's needs and can provide valuable insights. This may involve input from teachers, parents, medical professionals, or other relevant stakeholders who can contribute to the evaluation process.
7. Submit the completed form: Once all sections of the 504 referral form have been completed, ensure that it is signed and dated by the appropriate parties. Follow the specified submission process, whether through the school administration, guidance counselor, or designated 504 coordinator.

Who needs a 504 referral form?

A 504 referral form is typically needed for students who may have a disability that significantly impacts their ability to participate in or access their education. This could include students with physical impairments, mental health conditions, learning disabilities, chronic health conditions, or any other impairment that substantially limits their major life activities. Parents, teachers, school administrators, or other individuals involved in a student's educational journey may initiate the process by completing and submitting the 504 referral form.

For pdfFiller’s FAQs

What is 504 referral form?

504 referral form is a document used to refer a student for accommodations under Section 504 of the Rehabilitation Act of 1973.

Who is required to file 504 referral form?

School personnel, parents, or guardians can file a 504 referral form for a student.

How to fill out 504 referral form?

The form typically requires information about the student's disability, recommended accommodations, and other relevant details.

What is the purpose of 504 referral form?

The purpose of the 504 referral form is to ensure that students with disabilities receive the necessary support and accommodations in their educational environment.

What information must be reported on 504 referral form?

The form may require details about the student's medical condition, academic performance, and specific accommodations needed.

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