• Special ed, 504 forms and samples
From Afehandbook
Revision as of 18:34, 26 April 2006
504 Form Sample
504 FORM FOR STUDENTS WITH ANY TYPE OF DISABILITY
(Note: Accommodations are determined by needs of disability, so this list does not include all possible accommodations.)
AFE Student Name Here (STUDENT Z)
Section 504 Service Plan Date Written here: Summary of Assessment: Please refer to 10/7/2006 Spec. Ed Assessment report and letter from physician. STUDENT Z has diagnosis of dyslexia, dysgraphia, and processing issues.
Long Term Educational Goals: Long term goal: Successful completion of classes in 8th grade and junior high school diploma Educational objective: Successful academic participation in classes
Modifications and Accommodations
School responsibility:
- Supply "Books on Tape" for academic subjects, - allow use of keyboard for all written work, - reduced amount of written assignments, - extra time allowed for processing, testing, and any handwritten tasks.
- Allow student to demonstrate knowledge through verbal report or other media (artwork, video, models, etc.)
Student responsibility:
- Student will request accommodations when needed.
- Student will meet with teacher once per month.
Parent responsibility:
- Parent will support student in requesting accommodations and communicate with staff if needs are not being met.
Communication schedule: Once per month
