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Portland Public Schools

Portland Public Schools

Portland, Oregon Portland, Oregon

501 N. Dixon St•Portland, OR 97227•(503) 916-2000

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Student Success and Health

  • Department Main Page
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    • Gender Diversity Support Guide
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  • Section 504
  • 504 Forms & Manuals
  • 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)

    English | Chinese | Russian | Somali | Spanish | Vietnamese


    Medical or Health Assessment Statement
     
    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)

    English | Chinese | Russian | Somali | Spanish | Vietnamese


    Section 504 Eligibility Determination Report (pdf)

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


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


    Section 504 Action Form: Continuation, Termination 

    Section 504 Student Action Plan


    Temporary Medical Condition Accommodation Request (WORD fillable)
    Temporary Medical Condition Accomodation Request

    ___________________________________________________________________________________

    Other Section 504 Forms

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


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

    ___________________________________________________________________________________

    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

    _______________________________________________________________________________________________

    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.

Portland Public Schools

501 N. Dixon St

Portland, OR 97227

(503) 916-2000

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Portland Public Schools recognizes the diversity and worth of all individuals and groups and their roles in society. It is the policy of the Portland Public Schools Board of Education that there will be no discrimination or harassment of individuals or groups on the grounds of age, color, creed, disability, marital status, national origin, race, religion, sex or sexual orientation in any educational programs, activities or employment.

ADA Accessibility/District 504 Contact: 503-916-5460
ADA Employment Queries Contact: 503-916-3544
Title VI Contact: 503-916-6499
Title IX Contact: 503-916-3340
District Complaint Resolution Process

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