504 Form (En/sp)
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2504 Forms
Student Name: _____________________________________DOB: ___________________
Student Number: ___________________ Gr: _________ School: ___________________
504 Date: ___________________ Counselor: _____________________________________
☐ #1 Referral (initial 504)
☐ #2 Notice and Consent for Evaluation (initial 504)
☐ #3 Parent Rights in English and Spanish (mandatory EVERY time you meet)
☐ #4 Teacher Input (initial 504)
☐ #5 Parent Input (initial 504)
☐ #6 Notice of Meeting in English and Spanish (mandatory for EVERY meeting)
☐ #7 504 Initial Evaluation Form (initial 504)
☐ #8 Evaluation Results in English and Spanish (Only Necessary if Parent Doesn’t Attend)
☐ #9 Parent Consent (mandatory for initial 504)
☐ #10 Accommodation Plan (mandatory for initial 504/re-eligibility)
☐ #11Behavior Addendum (if necessary – Accommodation Plan must accompany the plan)
☐ #12 Annual Review (short version for annuals)
☐ #13 Manifestation Review
☐ #14 Manifestation Review Evaluation Results
☐ #15 Home Hospital Supplement (mandatory supplement for H&H)
☐ #16 Transportation
☐ #17 Release of Information
☐ #18 Assistive Technology
Initials
Forms (mand)
#1 (Referral)
#2 (Consent)
#3 (Rights)
# 6 (Mtg. Notice
#7 (Eval Form)
#9 (Parent
#10 (Acc. Plan)
Consent for 504)
Annuals
Forms (mand.)
#6 (Mtg. Notice)
#3 (Rights)
#12 (Annual
Review
BEST PRACTICE
Intitials
#4 (Teacher Input)
#5 (Parent Input)
Other Forms As Necessary – Whole Packet Sent to Counseling Office.
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