Section 504 Plan and Accommodation Documentation Form

Documents a student's Section 504 eligibility, accommodation plan, implementation details, and review schedule to support access under Section 504 and the ADA.

Submission Notice and Privacy Disclosure

• Purpose of this submission
• I understand this form collects student PII for official school records and accommodation planning.
• Consent to document accommodations and share with staff who need the information to implement the plan

Student and Case Identification

• Student full name
• Student ID
• Date of birth
  Collect only if needed to match the student record.
• School name
• Case manager or 504 coordinator
• Meeting date

Eligibility Determination

• Section 504 eligibility determination
• Major life activity impacted
• Summary of substantial limitation
  Describe the functional impact without unnecessary medical detail.
• Type of supporting information reviewed
• Is medical information required for this determination?
• Minimum necessary medical summary
  Use minimum necessary information only.

Accommodation Plan

• Classroom accommodations
  Enter each accommodation separately so implementation can be tracked clearly.
• Testing accommodations
• Behavioral or self-regulation supports
• Assistive technology needed
• Assistive technology details

Implementation and Responsibility

• Implementation start date
• Staff notification method
• Responsible parties
• Implementation notes
  Include any progressive disclosure needed for specific classes, activities, transportation, or extracurricular settings.

Review, Sign-Off, and Audit Trail

• Review frequency
• Next review date
• Parent or guardian acknowledgment
• Team lead signature
• Audit trail notes
  Document meeting notes, version changes, and any follow-up actions.