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Run: Section 504 Plan and Accommodation Documentation Form

A Section 504 Plan and Accommodation Documentation Form for recording eligibility, accommodations, implementation details, and review dates in one place. Use...

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Submission Notice and Privacy Disclosure

Purpose of this submission

I understand this form collects student PII for official school records and accommodation planning. (required)

Yes No N/A

Consent to document accommodations and share with staff who need the information to implement the plan (required)

Yes No N/A

Student and Case Identification

Student full name (required)

Student ID (required)

Date of birth

Collect only if needed to match the student record.

School name (required)

Case manager or 504 coordinator (required)

Meeting date (required)

Eligibility Determination

Section 504 eligibility determination (required)

Major life activity impacted (required)

Summary of substantial limitation (required)

Describe the functional impact without unnecessary medical detail.

Type of supporting information reviewed

Is medical information required for this determination? (required)

Minimum necessary medical summary

Use minimum necessary information only.

Accommodation Plan

Classroom accommodations (required)

Enter each accommodation separately so implementation can be tracked clearly.

Testing accommodations

Behavioral or self-regulation supports

Assistive technology needed (required)

Assistive technology details

Implementation and Responsibility

Implementation start date (required)

Staff notification method (required)

Responsible parties (required)

Implementation notes

Include any progressive disclosure needed for specific classes, activities, transportation, or extracurricular settings.

Review, Sign-Off, and Audit Trail

Review frequency (required)

Next review date (required)

Parent or guardian acknowledgment

Team lead signature (required)

Audit trail notes

Document meeting notes, version changes, and any follow-up actions.

Get your results

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Email (required)

Your name (optional)

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