SECTION 504 ACCOMMODATION PLAN
Date: _______________________ Date of Initiation of Plan: _____________________
Student: _______________________ School: ___________________ Grade: ______
NOTE: If the student is deemed eligible under Section 504, the student is entitled due process protections, including manifestation determinations, regardless of whether the student is provided with any services under this Section 504 Plan.
Summarize needs related to disability: _________________________________________________________________________________________ _________________________________________________________________________________________ __________________________
Accommodations:_____________________________________________________
Accommodations/Adaptations
Responsibility
Location
Signature of Team Members
Title
Agree
Disagree
(Copies provided to guardian, principal, classroom teachers, and counselors.)
REVIEW
Date
Continue Plan (Comments)
Counselor
Parent(s)
(Significant changes should be written on a new form and attached to the originals.)
