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RESETPRINTChino Valley Unified School District
Student Support ServicesSection504
REFERRAL AND REQUEST
FOR SECTION 504 EVALUATION
Date of 504 Plan Meeting
Student\'s NameD ate of BirthSchool YearSchoolPerm
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How to fill out section 504 referral and

How to fill out section 504 referral and
01
To fill out a Section 504 referral, follow these steps:
02
Start by gathering all relevant information about the student, including their name, grade, and any pertinent medical, psychological, or educational records.
03
Identify the reason for the referral. Determine if the student has a physical or mental impairment that substantially limits one or more major life activities, such as learning, walking, seeing, hearing, or self-care.
04
Consult with the student's teachers, parents, and other professionals involved in their education to gather additional insights and information about the student's needs and challenges.
05
Complete the Section 504 referral form provided by the school or district. Ensure that all sections are filled out accurately and completely.
06
Attach any supporting documents, such as medical reports, assessments, or teacher observations, to provide further evidence of the student's impairment and need for accommodations.
07
Submit the completed referral form, along with the supporting documents, to the appropriate individual or department responsible for reviewing Section 504 referrals.
08
Follow up with the designated individual or department to ensure that your referral has been received and is being processed.
09
Be prepared to attend any meetings or evaluations required as part of the Section 504 evaluation process.
10
After the referral has been reviewed, a determination will be made regarding the student's eligibility for Section 504 services. If eligible, appropriate accommodations and support will be provided to meet the student's needs.
11
Monitor the student's progress and regularly communicate with the school or district regarding any changes or updates in the student's needs or accommodations.
Who needs section 504 referral and?
01
Section 504 referral is needed for students who have a physical or mental impairment that substantially limits one or more major life activities. These students may require accommodations or support to fully access and benefit from their education.
02
Examples of students who may need a Section 504 referral include:
03
- Students with a chronic health condition, such as asthma, diabetes, or epilepsy, that affects their ability to participate in school activities
04
- Students with a learning disability that substantially limits their ability to learn, read, write, or concentrate
05
- Students with a mental health condition, such as anxiety or depression, that impacts their ability to engage in social or academic settings
06
- Students with a physical disability that restricts their mobility or ability to perform self-care tasks
07
- Students with a sensory impairment, such as hearing loss or vision impairment, that affects their ability to communicate or access information
08
It is important to note that each student's situation is unique, and the determination of whether a Section 504 referral is necessary should be made on an individual basis, taking into consideration the specific needs and challenges of the student.
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What is section 504 referral?
Section 504 referral is a process that involves evaluating students who may require special accommodations or services due to a disability, ensuring compliance with the Rehabilitation Act of 1973.
Who is required to file section 504 referral?
Typically, teachers, school counselors, or other educational personnel who observe persistent academic or behavioral issues in a student may be required to file a Section 504 referral.
How to fill out section 504 referral?
Filling out a Section 504 referral generally involves completing a designated form that details the student's needs, observations of their difficulties, and any prior interventions attempted.
What is the purpose of section 504 referral?
The purpose of a Section 504 referral is to initiate an evaluation process to determine if a student qualifies for accommodations or modifications to support their educational access due to a disability.
What information must be reported on section 504 referral?
The referral must typically include the student’s demographic information, description of the disability, evidence of the need for accommodations, and any previous support provided.
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