Get the free Referral to 504 Accommodation Team - BMRSD - bmrsd

Referral to 504 Accommodation Team Student Names: Grade: Date: Address: Phone Number: Date of Birth: Recommended 504 Team: Reason for Referral: Please Attach Supporting Documents (i.e. schedule, report

How to fill out referral to 504 accommodation

How to Fill Out Referral to 504 Accommodation:

1. Contact the appropriate office: Begin the process by reaching out to the office responsible for handling 504 accommodations. This is usually the office of the school principal or the district's 504 coordinator.
2. Obtain the referral form: Request a referral form for 504 accommodation from the office. They may provide a physical copy or allow you to download it from their website. If the form is not readily available, ask for guidance on submitting your request in a different format.
3. Provide personal and contact information: Fill in your personal details, including your name, address, phone number, and email address. This information helps the office to reach out to you for further communication or clarification if needed.
4. State the reason for the referral: Clearly articulate the reason why you are seeking a 504 accommodation. Include specific challenges or disabilities that require accommodation, being concise yet comprehensive in your explanation.
5. Attach supporting documentation: Attach any relevant documentation that supports your request for accommodation. This may include medical records, evaluations, or reports from healthcare professionals or specialists involved in your care. Ensure that these documents are up-to-date and address the specific accommodations you are seeking.
6. Specify requested accommodations: Clearly state the accommodations you are requesting, providing specific details. For example, if you require extra time for exams, indicate the amount of additional time needed. Be as specific as possible to ensure that your needs are clearly understood.
7. Sign and date the referral form: Once you have completed all sections of the referral form, sign and date it. This indicates that the information provided is accurate and that you are granting permission for the office to review and evaluate your request.

Who Needs a Referral to 504 Accommodation?

1. Students with disabilities: Any student who has a physical or mental impairment that substantially limits one or more major life activities may require a referral to 504 accommodation. This can include individuals with learning disabilities, attention-deficit/hyperactivity disorder (ADHD), sensory impairments, chronic illnesses, or psychological disorders, among others.
2. Parents or guardians: In cases where the student is a minor, the parents or legal guardians may initiate the referral to 504 accommodation process. They act as advocates for their child's needs and work collaboratively with educators and the school administration to ensure appropriate accommodations are provided.
3. School staff or professionals: School staff members who observe or become aware of a student's disability and the need for accommodations may also initiate a referral to 504 accommodation. This could include teachers, counselors, administrators, or specialized educational professionals who work closely with the student.

Remember, the process may vary slightly from school to school or district to district. It is essential to follow the specific guidelines provided by your educational institution when filling out a referral to 504 accommodation.

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