PROCEDURES FOR RECEIVING CONSIDERATION
FOR 504/ADA ACCOMMODATIONS IN THE SCHOOL SETTING
Community High School District #117 is committed to providing a free appropriate public education to each
resident disabled person who qualifies under Section 504 of the Rehabilitation Act of 1973 and the
Americans with Disabilities Amendments Act of 2008.
To qualify for accommodations under Section 504 of the Rehabilitation Act of 1973 or the Americans with
Disabilities Amendments Act of 2008, a student must have a physical or mental impairment which
substantially limits one or more major life activities, including but not limited to: learning, walking, seeing,
hearing, speaking, eating, sleeping, standing, lifting, communicating, concentrating, reading, breathing,
working, caring for one's self, thinking, performing manual tasks, lifting, and bending. (See 34 C.F.R. Section
104.3)
The specification of physical or mental impairment requires an individual evaluation which must be
administered by trained personnel with tests that are validated for the specific purpose for which they are
used. (34 C.F.R. Section 104.35) Many families will seek outside evaluations from pediatricians,
psychologists, psychiatrists, and other health professionals for diagnosis of a physical or mental impairment.
Documentation must be current and within a three year period to be considered.
It is important to remember that the presence of a physical or mental impairment does not automatically
guarantee eligibility under Section 504. That impairment must substantially limit one or more major life
activities for a student to be eligible.
If you feel that your student is eligible for accommodations under Section 504, the documentation supporting
this view should be submitted to the student's guidance counselor. Once the application and supporting
documentation is received by the 504 specialist, the student will be placed on the agenda for the next
available Student Support Team (SST) meeting. This meeting is chaired by the assistant principal and the
504 specialist is present. Other team members include the student's counselor, dean of students, school
psychologist, school social worker, and any other related service member working with the student can be
present. At this meeting a review of the student's academic records will be conducted, current teacher report
forms will be considered, a review of any outside evaluations will take place, and parental concerns will be
shared by the counselor and/or 504 specialist. All of this information will be used to determine if the student
meets the eligibility requirements under Section 504.
The Student Service Team (SST) may conclude that:
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The submitted materials, teacher feedback, and academic records support the need for protection
under Section 504.
The submitted materials, teacher feedback, and academic records do not support the need for
protection under Section 504 and no further action is necessary.
The submitted materials, teacher feedback, and academic records do not support the need for
protection under Section 504, but the student should be referred to the RtI Team to provide
interventions, monitor progress, and gather more information about the student.
The eligibility process generally takes 2-3 weeks depending on the time of year. It is important that the
process is conducted with fidelity and those teachers and the team have sufficient time to provide solid
feedback and review all relevant information. Therefore, applications received late in the school year may be
deferred to the beginning of the following school year. All incoming freshman applications received over the
summer or early in the school year will be held until the end of the 1st quarter (approximately 7-9 weeks)
prior to an eligibility review to allow our teachers time to get to learn about their student's needs, have a
sufficient number of data points, and allow the transition to high school time to settle.
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If a student is found eligible under Section 504, the plan will be developed and go into effect immediately.
The student's teachers will be notified of any accommodations the student might receive.
Completed forms are required to request consideration for eligibility under Section 504. This form can be
downloaded, printed, and should be filled out and returned to your student's counselor.
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Request for 504 Services
Student Name:
School:
Parent / Guardian:
Phone 1:
ID#
Counselor:
Phone 2:
If you feel that the student needs accommodations in his/her classes at Community
High School District #117, the documentation supporting this view should be
submitted with this request form to the Student Service Team (SST) through the
student's counselor.
1. What is the student’s perceived disability that is the basis for the requested
accommodations?
 Visual
 Learning
 Hearing
 Physical
 Other
(describe)_____________________________________________________
___
2. Documentation to support the need for the requested accommodation should:
a. State the specific disability and when it was initially diagnosed.
b. Be current (within the last three years).
c. In cases of medical diagnoses, the documentation must be no more than
one year old and should include the Doctor’s treatment plan.
d. Include the tests/techniques used to arrive at the diagnosis including the
dates of evaluation, test results with subtest scores and observations.
e. Establish the professional credentials of the evaluator including information
about license or certification and area of specialization.
f. Must describe how the impairment impacts daily functioning and how the
accommodation requested addresses this need.
The Student Service Team (SST) will meet to review all of the documentation,
including that submitted by you, and to determine whether or not the student’s
impairment SUBSTANTIALLY limits their learning, which is required to qualify for
accommodations. The 504 conference summary form will be completed at the
meeting.
Please complete and sign this form where indicated below. Then return it, with
your documentation, to your student’s counselor who will keep a copy and
forward the original, after signing it below, to the SST. This will insure that the
counselor remains informed.
You may address your mailings to the following addresses below:
Antioch Community High School, 1133 Main Street, Antioch, Illinois, 60002
Lakes Community High School, 1600 Eagle Way, Lake Villa, Illinois, 60046
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504 Accommodation: Parent/Guardian Report Form
The Student Service Team (SST) attempts to collect as much information about a
student as possible. In order to help the SST better understand your concerns as a
parent/guardian, please take a moment to answer the questions below and return it
with the application.
Student:
Disability:
Date:
1. How do you as the parent/guardian see the documented disability affecting your
child in the school setting?
2. How do you as the parent/guardian see the documented disability affecting your
child at home?
3. What interventions / accommodations have already been attempted to help your
child be more successful in school (I.E. - tutoring, level changes, counseling, etc.) ?
4. What are the biggest concerns you have for your child?
5. Is there any other information you feel would be relevant to the committee’s
decision making?
Parent Signature __________________________ Date
Initials__________
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Counselor