Groton Public Schools
Groton, Connecticut 06340
Section 504
Of The Rehabilitation Act Of 1973
Resource Packet
2014-2015
Groton Public Schools
Groton, CT 06340
2014-2015
District Compliance Officer
Denise Doolittle
Director PPS
The original 504 meeting paperwork
for ALL meetings are sent by the
building coordinator to the PPS
Office within 5 days of the meeting
School
504 Coordinator
Location of 504 Plans
Fitch High School
Thomas Bousquet
Guidance Director
Guidance Office
Cutler Middle School
Henry Martinez
Assistant Principal
Separate Folder
in Main Office
West Side Middle School
Jeff Kotecki
Assistant Principal
Separate File
in Guidance Office
Charles Barnum School
Donna Duley
Assistant Principal
Separate File
in Confidential File
Claude Chester School
Megan Bibby
School Psychologist
Top Drawer
of confidential File
Catherine Kolnaski Magnet
Elena Pollard
School Social Worker
Separate Drawer
in confidential File
Mary Morrison School
Katie Vanesse
School Psychologist
Separate File
in Main Office
Northeast Academy
Jennifer Criscuolo
School Psychologist
Separate Folder
in Confidential file
Pleasant Valley School
Allysa Hug
School Psychologist
Separate Drawer
in Confidential File
S. B. Butler School
Nancy Anderson
School Psychologist
Separate Drawer
in Confidential File
Groton Public Schools
Groton, Connecticut 06340
PARENT/STUDENT RIGHTS IN IDENTIFICATION,
EVALUATION AND PLACEMENT
UNDER
SECTION 504 OF THE REHABILITATION ACT OF 1973
The following is a description of the rights granted by federal law to students with disabilities.
The intent of the law is to keep you fully informed concerning decisions about your child and to
inform you of your rights if you disagree with any of these decisions.
You have the right to:
1. Have your child take part in, and receive benefits, from public education programs
without discrimination because of his/her disability.
2. Have the school district advise you of your rights under federal law;
3. Receive notice with respect to identification, evaluation, or placement of your child;
4. Have your child receive a free appropriate public education. This includes the right to be
educated with non-disabled students to the maximum extent appropriate. It also includes
the right to have the school district make reasonable accommodations to allow your child
an equal opportunity to participate in school and school-related activities.
5. Have your child educated in facilities and receive services comparable to those provided
to non-disabled students;
6. Have your child receive accommodations, modifications, and/or related services if he/she
is found to be eligible under Section 504 of the Rehabilitation Act;
7. Have evaluations, educational, and placement decisions made based upon a variety of
information sources, and by persons who know the student, the evaluation data, and
placement options;
8. Have transportation provided to and from an alternative placement setting at no greater
cost to you than would be incurred if the student were placed in a program operated by
the District;
9. Have your child be given an equal opportunity to participate in nonacademic and
extracurricular activities offered by the district;
10. Examine all relevant records relating to decisions regarding your child’s identification,
evaluation, educational program, and placement;
11. Obtain copies of your child’s educational records at a reasonable cost unless the fee
would effectively deny you access to the records;
12. Receive a response from the school district to reasonable requests for explanations and
interpretations of your child’s records;
13. Request amendment of your child’s educational records if there is reasonable cause to
believe that they are inaccurate, misleading or otherwise in violation of the privacy rights
of your child. If the school district refuses this request for amendment, it shall notify you
within a reasonable time, and advise you of the right to a hearing;
14. File a grievance related to decision(s) or action(s) regarding your child’s identification,
evaluation, educational program or placement; grievance requests must be made to the
Section 504 Coordinator;
15. Request a due process hearing related to decisions or actions made by the Section 504
Team. You and the student may take part in the hearing and have an attorney represent
you. Hearing requests must be made to the 504 Coordinator within 20 calendar days of
the parent’s receipt of notice of the 504 Team’s decision and the right to file for an
impartial hearing.
The person in this district who is responsible for assuring that the district complies with Section
504 is:
Denise A. Doolittle
Section 504 Compliance Officer
Groton Public Schools
P.O. Box K
Groton, CT 06340
Telephone: (860) 572-2152
Facsimile: (860) 572-2107
Please make all requests to utilize either the grievance procedure or the due process hearing
procedure in writing to the above address.
A discrimination complaint may also be filed with the Office for Civil Rights. All complaints
must be filed with OCR within 180 calendar days of the date of the alleged discrimination.
Office for Civil Rights
U.S. Department of Education
5 Post Office Square, Suite 900
Boston, MA 02109-3921
Telephone: (617) 289-0111
Facsimile: (617) 289-0150
October 2009
SECTION 504 MULTIDISCIPLINARY TEAM MEETING NOTICE
INITIAL ELIGIBILITY DETERMINATION MEETING
Date:
Parent(s)/Guardian(s):
Address:
Please be advised that your child_
, has been referred for consideration of
eligibility for accommodations under Section 504 of the Rehabilitation Act of 1973 (“Section 504”). A
meeting has been scheduled to consider your child’s eligibility for Section 504 accommodations on
(date) at
(time) at
(place).
Please let us know immediately if you would like to have this meeting re-scheduled to another date and
time to allow for your attendance.
During the Section 504 initial eligibility determination, the team will consider; (1) Whether your child has
a physical or mental impairment and, (2) Whether your child’s physical or mental impairment
substantially limits a major life activity. In considering whether the physical or mental impairment (if
any) substantially limits a major life activity, the team will consider whether the child; (1) Is unable to
perform a major life activity that the average person in the general population can perform or, (2) Is
significantly restricted as to the condition, manner or duration under which s/he can perform the major
life activity as compared to the condition, manner or duration under which the average person in the
general population can perform the activity. “Major life activities” are activities such as caring for
oneself, performing manual tasks, walking, seeing, hearing, speaking, breathing, learning, or working.
Please bring with you to the meeting any information which would be useful to the team in evaluating
your child’s abilities with respect to the standards described above. Relevant information might include
notes from the child’s treating physician or psychiatrist, psychologist or other therapist, prescription
information, and any evaluations you have obtained regarding the disabling condition.
The following individuals have been invited to attend the multidisciplinary team meeting:
Name and Title
Name and Title
You may bring with you to the meeting other individuals who have special knowledge regarding your
child and his/her disabling condition. If there is anyone else from the school staff who has not been
invited to the meeting whom you believe to be necessary to the process, contact me to discuss. If you
have any questions or wish to reschedule the meeting please contact me at _____________________.
(Telephone No.)
Sincerely,
____________________________________
(Name and Title)
□
A copy of your Parent/Student Rights under Section 504 is enclosed for your review and
information.
SECTION 504 MULTIDISCIPLINARY TEAM MEETING NOTICE
REVIEW OF INDIVIDUAL ACCOMMODATION PLAN
Date:
Parent(s)/Guardian(s):
Address:
Your child
has previously been identified as eligible for
accommodations under Section 504 of the Rehabilitation Act of 1973 (“Section 504”) and a
multidisciplinary team has developed an Individual Accommodation Plan (IAP) for your child.
A meeting has been scheduled for
(date) at
(time)
at
(place) to review the IAP and determine;
(1) whether your child continues to be eligible for Section 504 accommodations and, (2) if eligibility is
continuing, whether the IAP needs to be revised to reflect any changes in your child’s functioning. Please
let us know immediately if you would like to have this meeting re-scheduled to another date and time to
allow for your attendance.
Please bring with you to the meeting any information which would be useful to the team in evaluating
your child’s abilities with respect to the applicable standards under Section 504 as reviewed at the initial
eligibility meeting. Relevant information might include notes from the child’s treating physician or
psychiatrist, psychologist or other therapist, prescription information, and any evaluations you have
obtained regarding the disabling condition.
The following individuals have been invited to attend the multidisciplinary team meeting:
Name and Title
Name and Title
You may bring with you to the meeting other individuals who have special knowledge regarding your
child and his/her disabling condition. If there is anyone else from the school staff who has not been
invited to the meeting whom you believe to be necessary to the process, contact me to discuss. If you
have any questions or wish to reschedule the meeting please contact me at _____________________.
(Telephone No.)
Sincerely,
____________________________________
(Name and Title)
□
A copy of your Parent/Student Rights under Section 504 is enclosed for your review and
information.
GROTON PUBLIC SCHOOLS
GROTON, CONNECTICUT 06340
SECTION 504 MEETING SUMMARY/INDIVIDUAL ACCOMMODATION PLAN
Part I: Initial Information
Meeting Date: _____________________________
Name of Student: ____________________________________ Date of Birth: _____________________
Period of Accommodation Plan: ________________ to ____________________
Type of Meeting:
Review _____ New Referral ________
Grade: ___________________
504 Team Members Present:
Name and Title
Name and Title
Part II: Determination of Disability
Does the student have a physical or mental impairment?
Circle One:
YES
NO
If yes, what is the physical or mental impairment?
List sources of medical or other documentation:
Part III: Determination of Eligibility
Does the student’s physical or mental impairment substantially limit a major life activity? In determining
“substantial limitation”, consider whether:
a. The student is unable to perform a major life activity that the average person in the general
population can perform; or
b. The student is significantly restricted as to the condition, manner or duration under which the
average person in the general population can perform the same activity.
Circle One:
YES
NO
Name of Student: ____________________________________ Date of Birth: _____________________
If yes, what is the major life activity that the student cannot perform or is substantially limited in
performing as compared to the average student in the general population? (For example, walking, seeing,
breathing, speaking, learning, hearing, caring for oneself, performing manual tasks, working, eating,
sleeping, standing, lifting, bending, reading, concentrating, thinking, communicating)1:
Describe the impact of the disability on the major life activity identified above:
Rate the level of impairment to the major life activity on a scale from 1 to 5, with 1 being “little
impairment”, 4 being “substantial impairment” and 5 being “severe impairment”2:
Does this student require accommodations in the school setting?
Circle One:
YES
NO
Part IV: Individual Accommodation Plan
Having identified a physical or mental impairment:
that substantially limits the student in his/her ability to perform the major life activity of:
Name of Student: ____________________________________ Date of Birth: _____________________
1
A major life activity also includes the operation of a major bodily function, including but not limited to:
functions of the immune system, normal cell growth, digestive, bowel, bladder, neurological, brain,
respiratory, circulatory, endocrine, and reproductive functions. An impairment that substantially limits one
major life activity need not limit other major life activities in order to be considered a disability.
2 Any rating between 1 and 3 means that the level of impairment is not substantial and the student is not
disabled within the meaning of Section 504. Do not proceed to the next section. Close questions shall be
construed in favor of a finding that the student has a disability under Section 504. An impairment that is
episodic or in remission is a disability if it would substantially limit a major life activity when active. The
determination of substantial limitation is made without regard to the effects of mitigating measures such
as medications, equipment (except eyeglasses or contacts), devices, or adaptive neurological
modifications.
The team hereby establishes the following accommodation plan for the student to permit access to the
educational environment:
Accommodations
Settings/Location
Projected date for review: __________________________________
Minutes taken by: _________________________________________
Copy:
Central Office; School file; Parent; Staff
September 2014
Groton Public Schools
Groton, Connecticut 06340
SECTION 504
PARENT PERMISSION FOR SECTION 504 EVALUATION
Student Name:
School:
Parent(s) Name:
Address:
1.
DOB:
Age:
Grade
Telephone:
Notice:
A referral for a 504 evaluation has been initiated in order to determine eligibility and possible
accommodation(s) for a suspected physical or mental impairment that substantially limits a major life
activity. The reasons for this referral are:
Options considered and general education intervention procedures previously employed
Proposed Assessment/Techniques/Personnel: (specify)
Test/Evaluation Procedure
2.
Area of Assessment
Evaluator
Permission:
The evaluation will be conducted within 50 instructional days of parent permission. A 504 Conference
will be held to discuss the evaluation and any educational program recommendations. I understand the
reasons for the referral and the description of the evaluation process and have checked the appropriate box
below:
 Permission is given voluntarily to conduct the evaluation process as described.
 Permission is denied
3.
Rights and Options:
I have received a written copy of the Parent/Student Rights under Section 504 of the Rehabilitation Act.
Parent/Guardian’s Signature:
Date:
GROTON PUBLIC SCHOOLS
GROTON, CONNECTICUT 06340
SECTION 504
COMPLAINTS ABOUT FACILITIES OR SERVICES
Name: _________________________________________ Date: __________________
Address: ______________________________________ Telephone Number: ____________
Name of Student: __________________________________ Grade: ____________________
School: _________________________________________
Prior contacts with the 504 Team, Administrator, or Teacher: ____________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
Statement of Complaint: _________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
Action Requested: ______________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
Signature: ________________________________________ Date:__________________
Send to the person in this district who is responsible for assuring that the district complies with
Section 504:
Denise A. Doolittle
Director of Pupil Services
Groton Board of Education Administrative Office
1300 Flanders Road
Mystic, CT 06355
Copy: Central Office; School File; Parent; Staff
October 2009