Get the free Section 504 Student Referral Form 2 - ISD 191

ISD 191 SECTION 504 STUDENT REFERRAL Date: School: Student Name: Grade: Date of Birth: Parent(s)/Guardian(s) Name: Address: Parent Email Address: Phone Numbers: Work: Home: Cell: Primary language

How to fill out section 504 student referral

How to Fill Out Section 504 Student Referral:

1. Gather and review the necessary information: Before filling out the section 504 student referral, make sure you have all the relevant information about the student, including their name, grade level, specific needs, and any previous evaluations.
2. Identify the reasons for the referral: Clearly articulate the reasons why you are referring the student for a section 504 evaluation. This could include academic, behavioral, or health concerns that may be impacting the student's ability to fully participate in their education.
3. Provide detailed documentation: To support the referral, include any relevant documentation such as test results, progress reports, teacher observations, disciplinary records, and medical reports. This documentation will help establish the need for a section 504 evaluation.
4. Complete the referral form: Most schools have their own referral form for section 504 evaluations. Fill out the form accurately and thoroughly, providing all the required information. Be sure to include the student's personal details, identification of their specific needs, and any accommodations or services that have been tried in the past.
5. Obtain consent: In most cases, you will need to obtain written consent from the student's parent or guardian to proceed with the section 504 evaluation. Include a section in the referral form where the parent or guardian can indicate their consent and provide their signature.
6. Submit the referral: Once you have completed the referral form and obtained the necessary consent, submit the referral to the appropriate person or department at your school. This could be the school's section 504 coordinator or the designated contact person for evaluations.

Who Needs Section 504 Student Referral:

1. Students with disabilities: Section 504 of the Rehabilitation Act of 1973 protects the rights of individuals with disabilities in programs and activities that receive federal financial assistance. Any student who has a physical or mental impairment that substantially limits a major life activity, such as learning, should be considered for a section 504 referral.
2. Students experiencing academic or behavioral challenges: If a student is struggling academically or behaviorally and their difficulties are not solely due to a lack of appropriate instruction or limited English proficiency, a section 504 referral may be necessary. This referral can help identify if the student requires accommodations or additional support to address their challenges.
3. Students with chronic health conditions: Section 504 also applies to students with chronic health conditions that might limit their ability to learn or fully participate in school activities. This could include students with asthma, diabetes, epilepsy, or any condition that requires ongoing medical care or special accommodations.

Remember, the process of filling out a section 504 student referral may vary slightly depending on your school or district's policies and procedures. It is important to consult your school's section 504 coordinator or designated contact person for specific guidance.

For pdfFiller’s FAQs

What is section 504 student referral?

Section 504 student referral is a process where a student is referred for evaluation to determine if they require accommodations or services in a school setting due to a disability.

Who is required to file section 504 student referral?

Parents, teachers, school administrators, or any individual concerned about a student's potential need for accommodations due to a disability may file a section 504 student referral.

How to fill out section 504 student referral?

To fill out a section 504 student referral, one must provide information about the student's needs, their disability, and the accommodations or services requested. This form is typically available through the school district or the school's special education department.

What is the purpose of section 504 student referral?

The purpose of section 504 student referral is to ensure that students with disabilities are provided the necessary accommodations and services to have equal access to education.

What information must be reported on section 504 student referral?

Information such as the student's name, grade level, disability, current accommodations, and reasons for referral must be reported on a section 504 student referral.

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