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Section 504 Referral Form 4, page 1 of 4 Section 504 Referral (Attach extra pages as necessary) Student: Student ID #: Date of Birth: Grade: Referral Date: Campus: Referred by: Position/Relation to

How to fill out section 504 referral form

How to fill out a Section 504 referral form:

1. Start by gathering the necessary information - Before filling out the Section 504 referral form, make sure you have all the relevant information handy. This may include the student's name, date of birth, grade, and the reason for the referral.
2. Identify the requesting party - Indicate whether you are the parent or guardian of the student, a teacher, counselor, or any other individual making the referral. Provide your name, contact information, and your relationship to the student.
3. Explain the reason for the referral - Clearly state the reasons why you believe the student may require a Section 504 evaluation. This could be due to a physical or mental impairment that substantially limits one or more major life activities, such as learning, speaking, or mobility.
4. Provide supporting documentation - Attach any relevant documents or assessments that support the need for a Section 504 evaluation. These may include medical records, teacher observations, achievement test results, or individualized education plans (IEPs) previously implemented.
5. Specify accommodations or services needed - In this section, clearly outline the specific accommodations or services that you believe the student requires to receive an equal educational opportunity. These accommodations can help level the playing field and address any identified barriers faced by the student.
6. Sign and date the form - Once you have completed all the necessary sections, sign and date the form to indicate your consent for the Section 504 evaluation. If you are not the student's parent or guardian, ensure that you have obtained their permission and signature.

Who needs a Section 504 referral form?

1. Students with disabilities - Section 504 referral forms are typically needed for students who have a physical or mental impairment that substantially limits one or more major life activities. This can include students with medical conditions, learning disabilities, attention difficulties, or mobility impairments.
2. Parents or guardians - Parents or guardians of students with disabilities may need to fill out a Section 504 referral form in order to request that their child be evaluated for accommodations or services under Section 504 of the Rehabilitation Act.
3. School personnel - Teachers, counselors, or other school personnel who have identified a student's need for accommodations or services may also be required to complete a Section 504 referral form. This allows them to formally refer the student for evaluation and potential implementation of accommodations or services.

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What is section 504 referral form?

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

Who is required to file section 504 referral form?

School staff, parents, or guardians can file a section 504 referral form.

How to fill out section 504 referral form?

Section 504 referral form should be completed with detailed information about the student's needs and the reason for the referral.

What is the purpose of section 504 referral form?

The purpose of section 504 referral form is to identify students who may need accommodations or services due to a disability.

What information must be reported on section 504 referral form?

Information such as the student's name, grade, specific needs, medical documentation, and the reason for the referral must be reported on section 504 referral form.