Form 1
Iredell-Statesville Schools
Request for Permission for Section 504 Evaluation
Today’s Date
Dear
On
Parent or Guardian date of referral
:
, we received a request for your child, student’s name, ID number, date of birth
, to be evaluated for eligibility to receive accommodations under Section 504 of the Vocational
Rehabilitation Act of 1973. A copy of the Section 504 Request for Consideration form is enclosed for your information. Also enclosed is Parental Rights: Section 504 of the Vocational Rehabilitation Act of 1973 .”
Please review the information on your child, check one of the responses below, and sign and date the form. Please return the form to me. If you have any questions, please contact me at your convenience.
Thank you.
Section 504 Coordinator Date
Telephone
Parental Response to Request for Permission for Section 504 Evaluation
I give Iredell-Statesville Schools my permission to conduct an evaluation of the above named student for eligibility for accommodations under Section 504 of the Vocational rehabilitation Act of
1973.
I do not give Iredell-Statesville Schools my permission to conduct an evaluation of the above named student for eligibility for accommodations under Section 504 of the Vocational rehabilitation Act of 1973.
Please contact me so that I can get more information.
Parent/Guardian/Adult Student Date
Telephone