Editing • Special ed, 504 forms and samples

'''504 Form Sample''' This form should be available at the Resource Center, the main campus office, or through the special education office.  Officially, there should first be a meeting with the student, parent, teacher, other staff member, principal or other educational professional or special ed professional to determine eligibility and appropriate accommodations.  Accommodations lists can vary greatly.  Refer to the binder for longer list of possible accommodations for students. (Compiled by Nancy Winans)

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