Get the free Section 504 Initial Referral Form

Public Schools of Pentosan Section 504 Initial Referral Form Date of Referral: Students Full Name: Grade & Birth Date: Parent(s) or Guardian(s): Phone Contact Numbers: Reason for Referral: General

How to fill out section 504 initial referral

How to fill out section 504 initial referral:

1. First, gather all relevant information about the individual who may require accommodations under Section 504. This includes their name, age, contact information, and any medical or psychological diagnoses they have received.
2. Next, identify the reason for the referral. It could be due to a physical disability, medical condition, or any other impairment that substantially limits one or more major life activities.
3. Specify the accommodations or services that are being sought for the individual. These can include modifications to the physical environment, assistive technology, individualized instruction, or any other necessary support.
4. Provide a detailed description of how the individual's impairment impacts their ability to participate in major life activities, such as learning, communicating, or interacting with others.
5. Include any relevant medical or educational records that support the need for accommodations. This can include doctor's notes, evaluations, Individualized Education Programs (IEPs), or any other documentation that provides insight into the individual's needs.
6. Finally, sign and date the referral form, ensuring that all required fields are completed accurately. Submit the referral to the appropriate school or organization responsible for the implementation of Section 504 accommodations.

Who needs section 504 initial referral:

1. Individuals with physical disabilities that affect major life activities, such as walking, seeing, or hearing.
2. Students with medical conditions, such as diabetes, asthma, or epilepsy, that require accommodations in order to participate fully in school.
3. Individuals with mental health conditions, such as anxiety disorders or ADHD, that impact their ability to learn, concentrate, or interact with others.
4. Individuals with other impairments, such as speech or language disorders, learning disabilities, or chronic health conditions, that substantially limit one or more major life activities.

In summary, the section 504 initial referral is necessary for individuals who have impairments that substantially limit their ability to participate in major life activities. By following the steps outlined above, you can effectively fill out the referral and ensure that the individual's needs are properly addressed.

For pdfFiller’s FAQs

What is section 504 initial referral?

Section 504 initial referral is a process by which individuals with disabilities or students suspected of having disabilities are referred for an evaluation to determine if they qualify for accommodations or services under Section 504 of the Rehabilitation Act of 1973.

Who is required to file section 504 initial referral?

Educators, school administrators, parents, or the students themselves may file a Section 504 initial referral if they believe the student may have a disability that requires accommodations or services.

How to fill out section 504 initial referral?

To fill out a Section 504 initial referral, one must provide information about the student's disability, the impact of the disability on the student's education, and the accommodations or services being requested.

What is the purpose of section 504 initial referral?

The purpose of a Section 504 initial referral is to ensure that individuals with disabilities are identified and provided with the necessary accommodations or services to have equal access to education.

What information must be reported on section 504 initial referral?

The Section 504 initial referral must include information about the student's disability, its impact on education, any previous evaluations or assessments, and the accommodations or services being requested.

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