Section 504 Forms and Manuals

PPS SECTION 504 MANUAL (pdf) Procedures and Linked List of Forms.

 
Guide for Parents and Teachers: An introductory explanation of Section 504 in a Q & A format (pdf)
English | Chinese | Russian | Somali | Spanish | Vietnamese

 
Notice of Parent/Student Rights (pdf)
English | Chinese | Russian | Somali | Spanish | Vietnamese

Prior Notice/Parent Consent to Evaluate (pdf)
Prior Notice/Parent Consent to Evaluate (GoogleDoc)
English | Chinese | Russian | Somali | Spanish | Vietnamese

Medical or Health Assessment Statement 
Medical or Health Assessment (GoogleDoc)
Medical or Health Assessment (WORD fillable)
Medical or Health Assessment (pdf)

Release of Information (pdf)
English | Chinese | Russian | Somali | Spanish | Vietnamese

Section 504 Meeting Notice (pdf)
Section 504 Meeting Notice (GoogleDoc)
English | Chinese | Russian | Somali | Spanish | Vietnamese

Section 504 Eligibility Determination Report (pdf)

Eligibility Determination Report(GoogleDoc)
Eligibility Determination Report (WORD fillable)
English | Chinese | Russian | Somali | Spanish | Vietnamese 


Section 504 Student Accommodation Plan (pdf)  
504 Accomodation Plan (GoogleDoc)
504 Accommodation Plan (WORD fillable)
English | Chinese | Russian | Somali | Spanish | Vietnamese

Section 504 Action Form: Continuation, Termination 

Section 504 Student Action Plan (GoogleDoc)
Section 504 Student Action Plan (WORD Fillable)

Temporary Medical Condition Accommodation Request
Temporary Medication Condition Accomodation Request (GoogleDoc)
Temporary Medical Condition Accomodation Request (WORD Fillable)

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Other Section 504 Forms

504 Writing/Request Payment Form (pdf)
Afterschool Accomodation Request (pdf)
Home Instruction Referral (GoogleDoc)
Home Instruction Referral (WORD fillable)
Home Instruction Log (GoogleDoc)
Home Instruction Log (pdf)
Transportation Request Form (WORD fillable) 
Service Animal Request Form (pdf)

Section 504 Manifestation Determination (pdf)
Manifest Determination (GoogleDoc)
Manifest Determination (WORD fillable)
English | Chinese | Russian | Somali | Spanish | Vietnamese

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504 Document Submission Portal

Please submit the Section 504 Plan or Temporary Medical Condition Plan document to Student Success and Health via this form.

504 Document Submission Portal

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Uploading 504 documention to CUM/Docuware

Please use a Student Record Cover Sheet when submitting all 504 Documents to a student CUM file/Docuware.  Student Record Cover Sheets and accompanying documents should be given to building staff member responsible for uploading documents into Docuware.

Student Record Cover Sheet (pdf)

Click here for a quick reference sheet to assist in ensuring you submit the correct forms to the portal and to the student's CUM file.