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          Regional Education Cooperative #2
                     PO Box 230
                  Gallina, NM 87017
                  Ph# 638-5491x140
                    Fax# 638-0131
           Email: dtrujillo_jms@yahoo.com
         Executive Director: Dr. Danny Trujillo

                  Member Districts:
Chama Valley, Cuba, Dulce, Jemez Mountain, Mesa Vista,
                   Penasco, Questa

              Associate Member Districts:
    Espanola, Los Alamos, Pojoaque, Santa Fe, Taos
                         Table of Contents


  I.     Introduction and Purpose

  II.    504 Composition – Role

  III.   Sources of Referral to 504 (students, employees, parents),
         Eligibility, Definition

  IV. Recommended Reasons for Referral

  V.     504 Flowchart

  VI. 504 Procedures

  VII. Forms

         A. Pre-Referral Form
         B. Section 504/ADA Official Referral Record
         C. Notification of Meeting
         D. Meeting Guideline Checklist
         E. Evaluation of Data & Determination of Eligibility
         F. Due Process Notice & Forms (Student, Employee,
            Parent Rights)
         G. Accommodation Plan & Resource Sheets
         H. Review/Closure Form



      Mercy Romero, Assistant Superintendent, DI

           Dino Recla, Elementary Counselor

          Dale Cisneros, Elementary Counselor,

         Joe R. Atencio, Educational Consultant,

          William G. Reese, MS/HS Principal,

Augustin Valencia, Elementary Principal, 504 Coordinator,
                    Jemez Mountain

           Felipe E. Blea, MS/HS Counselor,

          Natalie Kannon, Special Ed. Teacher,

               I. INTRODUCTION & PURPOSE


Section 504 of the Rehabilitation Act of 1973 and the American
with Disabilities Act (ADA) are major federal legislative acts that
are designed to protect the civil rights of individuals with
disabilities. Both of these two federal laws are considered civil
rights legislation for persons with disabilities. And, their intent is
to prevent any form of discrimination based on disabilities.
Individuals with disabilities, who are otherwise qualified, are
protected. Section 504 applies to entities that receive federal funds,
while the ADA applies to virtually every entity except churches
and private clubs.

Section 504 and the ADA are having an incredible impact on
public schools across the country. Originally Section 504, which
was part of the broader 1973 rehabilitation act, was rarely
mentioned by public school personnel and was rarely used to
ensure equal educational opportunities. Public Law 94-142, which
was passed in 1975, was the federal legislation that initially
resulted in major changes in the way schools served children with
disabilities. This law, which was accompanied by federal funds,
was the focal point of schools in serving children with disabilities.
Section 504, and the ADA, which provided no funding, was often
considered less important for schools.

Recently, the role played by Section 504 and the ADA in schools
has increased dramatically; no longer are schools able to ignore
these two laws. As parents and advocated for children with
disabilities learn more about Section 504 and the ADA, schools are
having to respond to requests for protections and services. There
are several reasons why Section 504 and the ADA have become

more prominent in affecting services for children with disabilities,

   The American with Disabilities Act (ADA), passed in 1990,
    mandated nondiscrimination on the basis of disabilities
    nationwide, without restriction to federal funding. The law
    was passed with a great deal of publicity increasing the
    awareness of individuals about nondiscriminatory legislation.

   Certain disabilities not automatically resulting in eligibility
    for special education under Public Law 94-142 (now IDEA),
    such as attention deficit hyperactivity disorder (ADHD), have
    grown significantly in numbers. Because 504 and the ADA
    use a different definition of disability than IDEA, many are
    covered under these two acts.

   Parents’ awareness that Section 504 and the ADA can be
    used to provide certain protections for children who may not
    be considered eligible for special education under IDEA has
    increased greatly (Jacob-Timm & Hartshorne, 1994).

   The Office of Civil Rights (OCR) has increased enforcement
    efforts in the area of disability discrimination (Jacob-Timm
    & Harshorne, 1994)

   School personnel are more aware that some students who are
    not eligible for services under IDEA are eligible for services
    under Section 504 and the ADA.

   Attorneys have begun to realize that schools are often
    vulnerable to legal action under Section 504 and the ADA.

  Regardless of the specific reasons for the increase in attention to
  Section 504 and the ADA, the reality is that more and more
  parents are beginning to present requests to schools for services

and protections under these two laws. This fact has resulted in
more school personnel having to learn about Section 504 and
the ADA. As a result, schools must learn about the legal
requirements of these acts and specific services that are
required for children who are determined to have a
disability, as defined by Section 504 and the ADA, inn order
to provide appropriate services and protections to children
and to avoid litigation.

An example of the increased attention to Section 504 can be
seen as the legislation relates to children with ADHD. In 1991,
the U.S. Department of Education issued a policy statement, in
conjunction with the U.S. Office of Civil Rights and the Office
of Elementary and Secondary Education, regarding the
appropriate education for children with ADHD. The policy
clarified the responsibilities of schools to provide appropriate
programs for children with ADHD. The policy clarified the
responsibilities of schools to provide appropriate programs for
children with ADHD, noting that those not eligible for services
under IDEA could still qualify for protections and services
under Section 504 (Jacob-Timm & Hartshorne, 1994).

No otherwise qualified individual with a disability…shall
solely by reason of her or his disability, be excluded from
the participation in, be denied the benefits of, or be
subjected to discrimination under any program or activity
receiving Federal financial assistance.

PURPOSE: The purpose of this manual is to: Provide school
personnel with an overview of Section 504 and the ADA, and
specific, practical guidelines for schools to use when working
with children who are eligible for protections and services under
Section 504 and the ADA. An overview of the requirements of
504 and the ADA is included, as well as specific actions that
schools can initiate to ensure compliance. Sample letters, forms,

and policies are included to provide school personnel with
practical applications of the law.

                   II. 504 COMPOSTION - ROLE

Section 504 of the Rehabilitation Act and the Americans with
Disabilities Act are both civil rights statues for persons with
disabilities. Section 504 states that: The ADA is similar to 504 in
that it prohibits discrimination against otherwise qualified
individuals with disabilities.

Superintendent appoints 504 Compliance Officer. We strongly
recommend only one compliance officer be appointed for each
district. This officer will not be a counselor or special education

The coordinator will:
   Coordinate the implementation of all aspects of 504 and
     ADA with each building principal & include at their
     discretion a 504 committee (if requested)
   Serve as a resource person to district staff concerning
     interpretation of 504/ADA requirements
   Keep up to date with any changes in 504 or the ADA that
     impact the school district
   Collect and maintain materials and resources related to 504
     and the ADA for staff use.
   Coordinate staff in-service training related to 504 and the
   Coordinate the review and updating of the 504/ADA policy
   Coordinate delivery of 504/ADA services to eligible students
     at the building level in cooperation with the building
   Receive parent/guardian requests for impartial hearings or
     complaint investigations
   Coordinate the district’s “Child Find” for 504/ADA services
   Keep the superintendent informed concerning issues related
     to 504” for 504/ADA services

 Keep the superintendent informed concerning issues related
  to 504/ADA
 Collect and process information/records related to 504/ADA
 Maintain a district-wide listing of students served under
 Inform parents and employee of due process rights

                 III.   SOURCES OF REFERRAL
                         (Students, Employees, Parents)

Sources of Referral

  1. Self-Referral
     (B y parents, school staff, or students)
  2. SAT
  3. Other support teams unique to each school
  4. Any school staff or parent/guardian


Individuals (students, staff or parents) with disability or disabling
conditions who do not qualify under Individuals With
Disabilities Education Act (IDEA), which uses the following

   Mental retardation
   Learning disability
   Emotional disturbance
   Orthopedic impairment
   Hard of hearing
   Deaf
   Visual impairment
   Blind
   Autism
   Traumatic brain injury
   Other health impairment
   Speech impairment

For section 504, individual(s) must be otherwise qualified by
having a disability or disabling condition excluded by IDEA. The
individual must have been able to accomplish tasks before
disability or disabling condition set in, or has

qualifications/skills/ability to   do   tasks   independent   of
limitations due to disability.

Individuals being considered for 504 must have a physical or
mental impairment, which substantially limits one or more of
major life activities such as:

   Caring for oneself               Working
   Walking                          Sitting
   Seeing                           Stooping
   Performing manual tasks          Reaching
   Hearing                          Eating
   Speaking                         Procreating
   Breathing                        OHI that would not
   Learning                          qualify under IDEA


The 504/ADA defines a physical or mental impairment as:
  (A) Any physical disorder or condition, cosmetic
       disfigurement, or anatomical loss affecting one or more
       of the following body systems: neurological;
       musculoskeletal; special sense organs; respiratory;
       including speech organs; including cardiovascular;
       reproductive; digestive; genito-urinary; hemic and
       lymphatic; skin; and endocrine; or
  (B) Any mental or physiological disorder, such as mental
       retardation, organic brain syndrome, emotional or
       mental illness, and specific learning disabilities.

  ** PLEASE NOTE: Section B, similar to the categorical
  definition of disability found in IDEA. However, Section A,
  while including some of the categories found in IDEA, goes
  well beyond those specific areas in defining disability.

  In order to be eligible for special education under IDEA, a
  student must have a categorical disability, and that the disability
  must result in the students needing special education. However,
  It must be remembered that under Section 504/ADA, a child
  can be determined to have a disability without a diagnosis
  (psycho-educational evaluation) in any specific disability

   For 504 eligibility there must be substantial limits to
   performing major life activities determined by the following
   1) nature and severity of impairment;
          Is the impairment mild or severe?
          Does the impairment result in failure or the student’s
            not achieving near expected levels?
          Does the impairment impact on a major life activity? If
            so, how?
   2) duration or expected duration of impairment;
          Will the impairment be of such short duration as to not
            cause significant problems?
          Will the impairment cease impacting on the child
            without any intervention?
   3) permanent or long-term impact resulting from the impairment
          Will the impairment be short or long in duration?
          If the impairment is of short duration, will it have a
            significant impact without intervention?
          If the impairment will be long term, will the impact
            negatively affect the child’s status, academically,
            socially, emotionally, or behaviorally?
**Please remember that substantial limitation for 504 eligibility
signifies lower than average performance in general population
due to disability or disabling condition.


Because the definition of disability drives eligibility for
protections and services under 504 and the ADA, it is the basis
for determining that receives services and protections. Since
the definition used in these two laws differs significantly from
the definition used in IDEA, different individuals are covered
than would be eligible for special education services under
IDEA. Those covered will include:

   Students
   Staff
   Parents

Students Covered Under 504 and the ADA
As noted above, the broader definition of disability used in Section
504 and the ADA makes many children eligible for protections
under the act that are not eligible for special education under
IDEA. Martin (1992) suggests that the following types of
disabilities are likely covered under Section 504 and the ADA but
not under IDEA:

   Students with ADD or ADHD
   Students with learning disabilities who do not manifest a
    significant discrepancy between intellectual ability and
   Students who are transitioned out of special education
   Students considered to be socially maladjusted
   Students who have a history of drug and alcohol abuse
   Students with health needs
   Students with communicable diseases, such as AIDS

Because the definition of disability and the requirements for
eligibility under IDEA are more restrictive than those used in 504
and the ADA, all children eligible for services under IDEA are
eligible for protections under Section 504 and the ADA.
However, there are many children eligible for services and
protections under 504 and the ADA who are not eligible for
services under IDEA.

While children served under IDEA do not need an individual
accommodation plan under 504 and the ADA, there may be
instances where discrimination under 504 and the ADA is an issue.
For example, extracurricular activities, such as field trips, might
result in a 504/ADA issue for students served under IDEA.

School personnel should remember that determining that a student
has a disability, such as ADHD, is not a requirement for eligibility.
“Because the law makes not mention of specific categories of
disability or conditions considered as handicapping, evaluations for
Section 504/ADA eligibility do not require the school to ascertain
whether a specific disability is present in order for the child to be
determined eligible for services. “Section 504 (and the ADA) only
requires the presence of a physical or mental impairment that
substantially limits a major life activity.” (Reid & Katsiyannis,
1995, p. 45) The laws do not provide an exhaustive list of these

After dealing with IDEA for many years, school personnel
frequently have difficulty understanding that a child may be
eligible for services, as disabled, without a specific disability
category being attached to the child. The functionality of the
definition and eligibility criteria require that students be looked at
based on the impact of a disability, rather than the clinical nature
of the disability itself. This means that school personnel, through
the use of their professional judgment, have much greater
flexibility in determining eligibility for 504 and the ADA services
and protections than they have in determining eligible for IDEA
services. In determining eligibility, it is advised that an LEA
should request a Medical Provider’s recommendation for
504/ADA placement.

Staff covered by 504 and the ADA

In addition to students covered by Section 504 and the ADA,
school personnel must also deal with adults who have disabilities
under these two acts. School employees and parents of students in
the school district may be covered. If a school employee has a
disability covered under Section 504 and the ADA, then the school
must make reasonable accommodations for the individual to enable
him to perform the essential functions of the job. This means that

for applicants with disabilities covered under 504 and the
ADA, the school must determine if the individual can perform the
essential functions of the job with reasonable accommodations.

Individuals with disabilities do not receive any preference in the
job application process. Rather, their disability cannot be used as a
reason for not giving them a job if they are the most qualified
applicants. And, schools must ensure that all areas of employment,
including announcing openings, the application process,
interviews, selection of employees, payment of employees, and
benefits, meet the equal treatment and opportunities requirements
of Section 504 and the ADA.

If an employee develops a disability while working, the same
standard of being able to perform the essential functions of the job
with reasonable accommodations applies. In other words, if after
becoming disabled an employee can no longer perform the
essential functions of the job, with reasonable accommodations,
then the school may terminate the individual. One reasonable
accommodation that the school must consider before termination is
transferring the individual to another position that he or she can
perform with reasonable accommodations. Now ever, the school is
not required to create a job that can be performed, nor terminate
another employee so the person with a disability has a position.

Parents covered by 504 and the ADA

Parents with disabilities, who have children in a school district, are
also eligible for certain protections under Section 504 and the
ADA. For example, if a deaf parent wants to have a parent-teacher
conference, the school must arrange for an interpreter and cannot
charge the parent for the interpreter. Obviously, the parent needs to
alert the school of this need, within a reasonable timeframe before
the meeting. But, after making such a request, the school must
provide an interpreter. If the meeting is a short interchange,

without any substantial information going back and forth, then
writing notes or using some technological aide may be a sufficient
accommodation. However, if the meeting requires extensive
dialogue, then an interpreter would be the necessary

Another example would be a parent in a wheelchair who wants to
observe his child in a physically inaccessible classroom. Given
sufficient notice by the parent, the school would need to make
accommodations that would enable the parent to observe his child.
The simplest action would be to move the child’s classroom for the
time the parent wanted to observe the child. Carrying individuals
in wheel chairs is never considered an appropriate accommodation
unless an emergency would dictate such actions.

When developing plans for Section 504 and ADA compliance,
school personnel must remember that employees and parents of
students may also be eligible for protections under these two laws.
Not giving employees and parents equal access and equal
opportunities may be a violation of their civil rights under these
two federal laws.

                    V. 504 FLOWCHART

                     District Compliance

                    Determination of
                    Principal/Parent or 504

              YES                             NO

                                                   Notify Parents
   Develop/Implement                               of Decision &
  Accommodation Plan                                Due Process

                                                   End of
(If applicable-long term)
 Annual / 3 Year Review


  See Forms: A-G


                                                                                  Form A
PRE-REFERRAL – Page 1 of 3
Reason for Referral

Check all that apply

       Oral Expression                      Spelling                       Hyperactivity

       Listening                            Math Calculation               Fine Motor

       Written Expression                   Math Reasoning                 Gross Motor

       Handwriting                          Word attacks skills            Attention

_____Reading Comp.                          Study Skills                   Parent Concern

       Organizational Skills         Other (Specifiy):

Educational impact of student performance

The student does not:

       Do well on teacher tests
       Perform as expected on daily homework
       Complete Homework
       Perform as expected on end of course testing
       Perform as expected on norm-referenced tests
       Remember things a short while after learning
       Remember activities that are sequential in nature
       Remember information from one occasion to the next
       Generalize new information
       Use words correctly from one situation to the next
       Understands meaning of words
       Answers questions after listening to orally presented information
       Keeps place when reading words or sentences
       Use word attacks skills properly
       Associate phonetic sound with corresponding letter
       Read without adult in close proximity
       Spell consistently
       Use addition, subtraction, multiplication, or division properly
       Solve word problems efficiently
       Use capitalization and other rules correctly
       Understands the meaning of place

                                                                                     Form A
PRE-REFERRAL – Page 2 of 3

Visual/Hearing Perceptual/Motor Performance

The student:
      Reverses letters
      Inverts letters
      Complains of hurting eyes
      Requires close visual attention
      Complains that letters are blurred
      Closes one eye while reading
      Erases excessively
      Reads better when part of page is shielded
      Is unable to recognize and match images, objects, letters, etc.
      Copies materials from board with many errors
      Sees no spaces between words or letters
      Makes letters in a strange way
      Writes in reverse
      Holds pencil incorrectly
      Writes illegibly
      Cannot cut paper along lines
      Produces untidy work
      Has difficulty performing activities involving concepts such as near and far
      Is not able to differentiate among sounds
      Does not perform well on tasks requiring listening
      Does not benefit from oral instruction
      Is not able to perform basic motor skills – skip, hop, etc.
      Has motor tics
      Has difficulties in activities requiring coordination or use of extremities
      Can tell but not write a story

Behavior-Attention Problems

The Student:
      Has unpredictable and explosive behavior
      Is unable to establish relationships with peers or adults
      Has inappropriate behavior during unstructured times
      Feels persecuted
      Does not accept responsibility
      Is unable to remain seated for extended periods
      Is unable to follow directions
      Interrupts others
      Cannot work quietly
      Is impulsive

                                                                Form A
PRE-REFERRAL – Page 3 of 3

Behavior-Attention Problems

The Student:
       Is Restless
       Cannot attend to detail
       Shouts answers
       Must be near teacher to maintain behavior
       Does not hear important sounds in the classroom

Pre-Referral Actions to address concerns:

Person making referral:


                                                                                       FORM B


Section 504/ADA Official Referral Record ------------------------------- CUM Folder

Note: This form should be completed only after a person’s problems have been addressed without
success through modifications and support team consultation.

Date of Referral:

Referring Person:

Name of Person being Referred:






Reason(s) for referral:

                            Referred to 504 Compliance Officer: __________________________

                                                                                    Form C


Notification of Meeting


To:   Name of Person Referred: ____________________________________________________

School or Address: _________________________________________________________________

Grade/Class: ______________________________________________________________________

Person & title that is initiating contact: _________________________________________________

Contacted by: _____________________________________________________________________

      _____ In person

      _____ By telephone on (date& time):____________________________________________

      _____ Notification Report (date): _______________________________________________

Conference Date: __________________________________________________________________

Conference Summary: ______________________________________________________________


From: 504 Compliance Officer Initiating Notification:_______________________

                                                                                         Form D

Meeting Guide Checklist

___1.   Introductions/Purpose

___2. Review Pre-Referral Form (A) , Official Referral Record Form (B) and Notification of
      Meeting Form (C)

___3. Review Determination of Eligibility Form (E)

___4. Review Due Process Forms (F)

___5. Complete Accommodation Plan (G)

___6. Review Closure Form (H)

___7. Obtain signatures from all 504 members (Remember the Parent)

___8 Set date for follow up meeting as needed

Subsequent 504 Meetings

___1. Introductions/Purpose

___2. Discuss Accommodation Plan for Strengths & Weaknesses

___3. Evaluate success of the intervention strategies and data

___4. Modify the SAME Accommodation Plan to include other accommodations as needed

___5. Make referrals to other resources as appropriate

___9. Obtain signatures from all 504 members (Remember the Parent)

___10. Set date for follow up meeting as needed

                                                                                         Form E -1

   Determination of Eligibility/Evaluation of Data

   Name: ____________________________________________________
   Date: _____________________________________________________

   504 Eligible?
              Yes
              No
   Projected Re-evaluation date:

Major Life      School-Related     Source of         Severity            Duration        Substantial
Activity        Description of     Information #2                                        Limitation?
                Impairment #1                                                            #3
                                                                         Short   Long
                                                     Mild-------Severe   Term    Term    YES           NO
 Caring for                                         1 2 3 4 5
 Walking                                            1   2   3   4   5
 Seeing                                             1   2   3   4   5
 Performing                                         1   2   3   4   5
 Manual Tasks
 Hearing                                            1   2   3   4   5
 Speaking                                           1   2   3   4   5
 Breathing                                          1   2   3   4   5
 Learning                                           1   2   3   4   5
 Working                                            1   2   3   4   5
 Sitting                                            1   2   3   4   5
 Stooping                                           1   2   3   4   5
 Reaching                                           1   2   3   4   5
 Eating                                             1   2   3   4   5
 Procreating                                        1   2   3   4   5
 OHI                                                1   2   3   4   5

   #1 Description of educational-related behaviors associated with specific major life activities
   affected by mental or physical condition
   #2 Listing of persons and/or evaluation techniques used for identifying behaviors associated with
   #3 Based on consideration of the nature; severity; and duration of the impairment

   Principal: _______________________________ Parent: ___________________________________
   Member: ________________________________ Member: _________________________________
   Member: ________________________________ Member: _________________________________

                                                                                            Form F -1


Due Process – Notice and/or Employee

                                   Section 504/ADA Policy Notice

The                           School District does not discriminate on the basis of disability with
regard to admission, access to services treatment, or employment in its programs or activities.

Section 504 of the Rehabilitation Act of 1973 prohibits discrimination against individuals with
disabilities in any program receiving federal financial assistance. The Americans with Disabilities Act
(ADA) applies to employers who have over 14 employees regardless of federal financial assistance.
Under both Acts, the definition of an “individual with a disability” is a person who:

    has a mental or physical impairment which substantially limits one or more major life
     activities, such as seeing, hearing, speaking, breathing, learning, or working;
    has a record of such impairment; or
    is regarded as having such an impairment.

The District will evaluate, identify, and provide free appropriate education to all students who are
individuals with disabilities under Section 504 or the ADA Parents of these students are entitled to
procedural safeguards, including individual notice and an impartial hearing.

The District will provide reasonable accommodation to each employee and qualified employment
applicant covered by Section 504 or the ADA unless it would impose an undue hardship on the
operation of the program.

Each of the programs of the District will be readily accessible to individuals with disabilities when
viewed in its entirety.

The District will furnish auxiliary aids and services to students, employees, parents, and members of
the public who have disabilities to the extent necessary for communications with other persons, unless
it will result in an undue burden on, or a fundamental alteration in the program.

The District has a grievance procedure for disability discrimination complaints. For a description of
this procedure, or any further relevant information, including the District’s updated staff evaluation,
contact the Section 504/ADA Coordinator:

Office Address

Phone Number

                                                                                             Form F -2


Due Process – Parent & Student

                      Notice of Parent and Student Rights under Section 504

The Rehabilitation Act of 1973, commonly referred to as “Section 504”, is a nondiscrimination statute
enacted by the United States Congress. The purpose of the Act is to prohibit discrimination and to
assure that disabled students have educational opportunities and benefits equal to those provided to
non-disabled students.

An eligible student under Section 504 is a student who (a) has, (b) has a record of having, or (c) is
regarded as having a physical or mental impairment which substantially limits a major lie activity such
as learning, self-care, walking, seeing, hearing, speaking, breathing, working, and performing manual

Dual Eligibility: Many students will be eligible for educational services under both Section 504 and
the Individuals with Disabilities Education Act (IDEA). Students who are eligible under the IDEA
have many specific rights that are not available to students who are eligible solely under Section 504.
A Parents Rights Handbook prepared by the New Mexico State Education Agency is available
through the school district’s Special Education Department and sets out the rights assured by the
IDEA. It is the purpose of this Notice form to set out the rights assured by Section 504 to those
disabled students who do not qualify under the IDEA.

The enabling regulations for Section 504 as set out in 34 CFR Part 104 provide parents and/or students
with the following rights:
   1. You have the right to be informed by the school district of your rights under Section 504. (The
       purpose of this Notice form is to advise you of those rights.) 34 CFR 104.32.
   2. Your child has the right to an appropriate education designed to meet his/her individual
       educational needs as adequately as the needs of non-disabled students are met. 34 CFR 104.33
   3. Your child has the right to free educational services except for those fees that are imposed on
       non-disabled students or their parents. Insures and similar third parties are not relieved from an
       otherwise valid obligation to provide or pay for services provided to a disabled student. 34
       CRF 104.33
   4. Your child has a right to placement in the least restrictive environment. 34 CFR 104.34.
   5. Your child has a right to facilities, services, and activities that are comparable to those proved
       for non-disabled students. CFR 34 104.34
   6. Your child has a right to an evaluation prior to an initial Section 504 placement and any
       subsequent significant change in placement. CFR 34 104.35

7. Testing and other evaluation procedures must conform with the requirements of 34 CFR
    104.35 as to validation, administration, areas of evaluation, etc. The district shall consider
    information from a variety of sources, including aptitude and achievement tests, teacher
    recommendations, physical condition, social and cultural background, adaptive behavior,
    physical or medical reports, student grades, progress reports, parent observations, anecdotal
    reports, and TEAMS/TAAS scores. 34 CFR 104.35
8. Placement decisions must be made by a group of persons (i.e., the Section 504 Committee)
    including persons knowledgeable about your child, the meaning of the evaluation data, the
    placement options, and the legal requirements for least restrictive environment and comparable
    facilities. 34 CFR 104.35
9. If eligible under Section 504, your child has a right to periodic reevaluations, generally every
    three years. 34 CFR 104.35.
10. You have the right to notice prior to any action by the district in regard to the identification,
    evaluation, or placement of your child. CFR 34 104.36
11. You have the right to examine relevant records. 34 CFR 104.36.
12. You have the right to an impartial hearing with respect to the district’s actions regarding your
    child’s identification, evaluation, or educational placement, with opportunity for parental
    participation in the hearing and representation by an attorney. 34 CFR 104.36.
13. If you wish to challenge the actions of the district’s Section 504 Committee in regard to your
    child’s identification, evaluation, or educational placement, you should file a written Notice of
    Appeal with the district’s Section 504 Coordinator (Insert name, address and telephone
    number) within                  calendar days from the time you received written notice of the
    Section 504 Committee’s action(s). A hearing will be scheduled before an impartial hearing
    officer and you will be notified in writing of the date, time, and place for the hearing.
14. If you disagree with the decision of the impartial hearing officer, you have a right to a review
    of that decision by a court of competent jurisdiction. 34 CFR 104.36.
15. On Section 504 matters other than your child’s identification, evaluation, and placement, you
    have a right to file a complaint with the district’s Section 504 Coordinator (or designee), who
    will investigate the allegations to the extent warranted by the nature of the complaint in an
    effort to reach a prompt and equitable resolution.
16. You also have a right to file with the Office of Civil Rights. The address of the Regional Office
    which covers New Mexico is:
    ?Name/Address/Phone number?

                                                                                 Form G
Section 504/ADA Accommodation Plan – Page 1 of 2

Name: ___________________________ School/Class: ________________________________
Teacher: _________________________ Date(s) of Accommodation Plan: _________________

General Strengths:

General Weaknesses:

Issue(s) of Concern and Suggested Accommodations:

                                       Accommodation #1



Person responsible for Implementation Accommodation:

                                       Accommodation #2



Person responsible for Implementation Accommodation:

                                                                                 Form G

Section 504/ADA Accommodation Plan – Page 2 of 2

                                     Accommodation #3



Person responsible for Implementation Accommodation:

                                     Accommodation #4



Person responsible for Implementation Accommodation:

Review/Re-evaluation Date:

Individuals Participating in the Development of Accommodation Plan:

Signature                     Date   Signature                   Date
____________________________________ _____________________________________________
                  Principal                           Parent
____________________________________ ____________________________________________
____________________________________ ____________________________________________
____________________________________ ____________________________________________

LEAST RESTRICTIVE ENVIRONMENT PLACEMENT: _______________________________


Adjustment Disorder               Agoraphobia                 Alcohol Addiction
Allergies                         Amnesia                     Amnestic Syndrome
Anemia                            Anorexia Nervosa            Avoidance Disorder
Bipolar Disorder                  Bulimia                     Blind
Conduct Disorder                  Cerebral Palsy              Chron’s Disorder
Chronic Motor Tic Disorder        Cirrhosis                   Cosmetic Disfigurement
Cyclothymic Disorder              Deafness                    Depersonalization Disorder
Diabetes                          Drug Addiction              Dysthymic Disorder Elective
Mutism                            Emotional Disturbance       Epilepsy
Functional Encopresis             Functional Enuresis         Generalized Anxiety Dis.
Hearing Impaired                  Heart Disease               Hemophilia
HIV Infection                     Hypochondriasis             Identity Disorder
Intermittent Explosive Disorder   Isolated Explosive Disorder Language Impaired
Lead Poisoning                    Learning Disabilities       Leukemia
Major Depression                  Mental Retardation          Mild Mental Retardation
Moderate Mental Retardation       Mononucleosis               Multi-Disabled
Multiple Personality              Neurological Deficit        Obsessive Compulsive Dis.
Oppositional Defiant Disorder     Organic Affective Syndrome Other Health Impaired
Overanxious Disorder              Panic Disorder              Paranoia
PDD                               Physiological Disorder      Pica
Post Traumatic Stress Dis.        Primary Dementia            Profound Mental Retardation
Proteus Syndrome                  Reactive Attachment Dis. Rheumatic Fever
Rumination Disorder               Schizoid Disorder           Schizophrenia
Seriously Emotionally Disturbed   Severe Mental Retardation Sickle Cell Anemia
Sleep Terror Disorder             Speech Impaired             Social Phobia
Tourette’s Syndrome               Stuttering                  Tuberculosis
Traumatic Brain Injury            Visually Impaired
Other (Specify):


      DC: ___________________________________________ Caring for Oneself
      DC: ___________________________________________ Walking
      DC: ___________________________________________ Seeing
      DC: ___________________________________________ Hearing
      DC: ___________________________________________ Speaking

Etc. Etc….

Adaptive Behavior Assessment     Audiological Evaluation    Classroom Work Samples
End of Course Testing            End of Grade Testing       Far-Point Vision Screening
Hearing Screening                Hospital Discharge Report IEP
Medical Evaluations              Near-Point Vision Screening     Neuro-psychological
Evaluation Observations          Occupational Therapy      Opthamological Evaluation
Otological Evaluation            Parental Conferences              Physical Therapy
Evaluations Psychological Report Reported Grades            State Testing Program Student
Work Samples                     Teacher Annotations        Vocational Assessments
Other (Specify):


_____ Special toilet accommodations               _____ Classes on First Floor of Buildings

_____ Seated near chalkboard                     _____ Seated near teacher’s desk

_____ Seated near Educational Assistant’s desk _____ Seated away from other students

_____ Provide a daily schedule of activities     _____ Allow to leave before bell rings

_____ Seated in study carrel                     _____ Utilize writing aides from OT

_____ Provided an additional set of books        _____ Provided tape recorder

_____ Provided with copy of lecture notes        _____ Provided with note taker

_____ Provided with necessary note taking materials

_____ Provided with written lists of information, and directions

_____ Moved closer to things that are being viewed

_____ Located in a room with minimized distractions

_____ Assigned to another school

_____ Other (Specify):


_____ Assigned to another school                 _____ Assigned to another classroom

_____ Referred to vocational rehabilitation      _____ Reassign to a different teacher

_____ Reassigned to a male teacher               _____ Reassigned to a female teacher

_____ Allowed to leave class early               _____ Assigned to counselor

_____ Variance from attendance policy            _____ Air purifier in classroom

_____ Training for teachers in learning styles   _____ Health Plan for student

_____ Monthly meeting with student’s teachers _____ Special Parking

_____ Provide special temperature control equipment

_____ Provide each teacher with a copy of accommodation plan

_____ Allowed to leave school before the end of the day

_____ Other (Specify):


_____ Daily posted schedule for student          _____ Extra time for assignments

_____ Students will repeat phrases/directions    _____ Assignments on larger lined paper

_____ Information presented in smaller chunks _____ More drill and practice activities

_____ Participation in Title I Programs

_____ Allowed to complete work late              _____ Allowed to tape lessons

_____ Provided with large print materials        _____ Provided with lecture notes

_____ Instructions for outlining key ideas       _____ Hand outs in large print

_____ Instructions in learning strategies        _____ Allowed taped text

_____ Participation in cooperative learning groups ____Visual instruction (overheads)

_____ Repeated or paraphrased instructions       _____ Instructions on test taking

_____ Assigned a behavior management plan        _____ Assigned a case worker

_____ Assistance from teacher’s aid              _____ Reminder about listening

_____ Information presented loudly               _____ Allowed to ask questions

_____ Reduced length of assignments

_____ Homework assignment notebook will be used

_____ Behavior checklists used for evaluation

_____ Other (specify):


_____ Role playing activities             _____ Periodic rewards for positive behavior

_____ Participate in group counseling     _____ Peer counselors

_____ Peer tutors                        _____ Use of time out when needed

_____ No touching other students         _____ Feet remain on floor

_____ Hands remain to self

_____ Attempt work independently before assistance is provided

_____ Participation in development in behavior management plan

_____ Other (specify):


_____ Take home test                     _____ Oral testing

_____ Reader during testing              _____ Test in large print

_____ Oral review of test material       _____ Open book test

_____ Reduced length of test             _____ Individually tested

_____ Test printed in Black              _____ Test printed in large black letters

_____ Provide with writer

_____ Tested with curriculum based assessment

_____ Other (specify):

                                                                                           Form H


Review/Closure Form for 504/ADA Plan---------------------------------------Cum folder

Name:                                               Date:
Date and reason for initial referral:

Reason for Review:

Record of Actions Taken:


-Updated Plan

Continue?       _____Yes                ____No       Please Explain:

Exit?           _____Yes                _____No      Please Explain:

Any referrals (to Special Education or other resource)?

Committee Members Signature”

Principal Signature                     Date        Parent Signature                    Date

Signature                               Date        Signature                           Date

Signature                               Date        Signature                           Date


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