Section 504 Notification Letter to Parents
<school name> does not discriminate in its educational programs and activities on the basis of a student’s
disability. We have reason to suspect that ____________________________________ may have a
physical or mental impairment that substantially limits a major life activity possibly making him/her
eligible for protection under Section 504.
We will be convening a team of individuals to determine whether accommodations may need to be made
to meet his or her individual needs as adequately as the needs of other students. We want to include
people on the team who know your child, and would especially value your input.
Once the information has been reviewed, we will be meeting with you to discuss plans to meet your
child’s needs. Please feel free to contact <name> (Section 504 Liaison or Appointee) at <School> with
any questions/concerns you may have.
Parents and students have specific rights under Section 504 of the Rehabilitation Act of 1973. These
rights are summarized and attached to this form.
Please provide your consent for us to accomplish this evaluation, by indicating your decision and
providing your signature (below) and returning the bottom half of this form to:
________________________________________________
Section 504 Liaison
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Parent Consent
The school asks your permission to conduct an evaluation in order to determine eligibility for Section 504
accommodations.
______________________________________________________ Date: _________________
Student’s Name
_________ Yes, I consent to the proposed screening/evaluation of my child for Section 504 eligibility.
_________ No, I do not consent to the proposed screening/evaluation of my child for Section 504
eligibility.
Comments:
______________________________________________________________________________
______________________________________________________________________________
I have received a copy of the Parent’s Notice of Section 504 Rights.
______________________________________
Parent Signature
Resource provided by AEA 267 @ 2009 and AEA 10
Archdiocese of Dubuque September 2013
_____________
Date
Section 504 Student and Parental Rights
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.
As a parent you have the right to the following:
• Participation of your child in educational programs and activities, including non-academic and
extracurricular programs and activities, to the maximum extent appropriate, free of discrimination based
upon the student’s disability and at the same level as students without disabilities;
• Reasonable accommodations to allow your child an equal opportunity to participate in school and
school–related activities.
• Be advised of your rights under federal law in your native language;
• Receipt of information with respect to Section 504 about your child and your child’s educational
programs and activities in your native language;
• Notice of identification of your child as having a qualifying disability for which accommodations may
need to be made and notice prior to evaluation and placement of your child and right to periodically
request a re-evaluation of your child;
• Have eligibility and educational placement decisions based upon a variety of information sources, and
by individuals who know the student, the eligibility data, and placement options;
• Inspect and review your child’s educational records including a right to copy those records for a
reasonable fee; you also have a right to ask the school district to amend your child’s educational records if
you feel the information in the records is misleading or inaccurate; should the school district refuse to
amend the records, you have a right to a hearing and to place an explanatory letter in your child’s file
explaining why you feel the records are misleading or inaccurate;
• File a complaint with the district when you believe your child’s rights have been violated.
• Request an impartial hearing regarding the Section 504 identification, evaluation, or educational
placement of your child. You and the student may take part in the hearing and have an attorney represent
you at your own cost.
Have your child receive special education and related services is she / he is found to be eligible under the
Individuals with Disabilities Education Act (IDEA) or to receive reasonable accommodations under
Section 504 of the Rehabilitation Act.
Resource provided by AEA 267 @ 2009 and AEA 10
Archdiocese of Dubuque September 2013