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Revised July 2015
Lincoln County Schools
SECTION 504 CHECKLIST FOR THE 504 COORDINATOR
(Parent Request)
STUDENT: _______________________________________
SCHOOL: ________________________________________
Parents who wish to make a request for the determination of a disability under Section 504, should do so by
doing the following:
 Completing the “Request for Section 504 Disability Determination” form.
 This form should be completed in as much detail as possible.
 Providing any additional information, including a medical diagnosis, psychological evaluation, etc….
The more information the parent can provide the better, as this will allow the team to make deliberate and
informed decisions.
___ Request received: Date___________
And includes:
___ “Request for Section 504 Disability Determination” form
___ Any additional supporting documentation/information from parent
**Because the parent made the request, the “Prior Notice and Parental/Guardian Consent for
Consideration” form is not necessary because consent is implied with the request.
___ Send to parent, “Notice of Section 504 Parental Rights”
Date sent: ___________
___ Have teachers complete the “Teacher Input” form
___ Have teachers provide “Documentation of Interventions” form
___ Have teachers provide “Documentation of Parent Contacts”
___ Schedule a meeting (within 20 days of receipt of the request) to discuss §504 eligibility.
___ Send to parent, “Notice of Meeting for Consideration for Section 504 Disability Determination” form.
(If email is the preferred method of contact with a parent, the email MUST include an
invitation to the meeting as well as notice of the meeting. Specific wording of this email
notification is in the 504 manual)
Date sent:___________
___ Put a copy of the “Notice of Meeting for Consideration for Section 504 Disability Determination” or a
copy of the email, if it is the preferred method of contact, in the student’s 504 folder.
© 2015- Mary Moren
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___ Student is presented at 504 meeting: Date ___________
___ Use the “Section 504 Initial Disability Determination & Reevaluation” form to determine eligibility.
If it is determined that the student IS DISABLED and therefore eligible for Section 504 protection, the
504 Team will do the following:
___ Determine if accommodations would be required in order for the student to have educational access
equal to that of his/her non-disabled peers
IF YES, the child DOES need an accommodation plan, the team will:
____ Develop the Accommodation Plan using the “Section 504 Equal Education
Opportunity/Accommodation Plan” form.
The Chairperson will:
___ Send the following to the parent (or if parent is present, make copies and give to parent):
Date sent:____________
___ “Parent/Guardian Notice of Section 504 Assessment Results” form. (n/a if parent present)
___ A copy of the “Section 504 Initial Disability Determination & Reevaluation” form.
___ A copy of the “Section 504 Equal Education Opportunity/Accommodation Plan”
___ Give each teacher a copy of the “Section 504 Equal Education Opportunity/Accommodation Plan”
form.
___ Have each teacher sign the “Section 504 Plan Acknowledgement” form.
___ Put originals of all forms in student’s 504 folder.
___ “Notice of Section 504 Protection” is placed in the student’s cumulative folder.
___ Copy of “Section 504 Equal Education Opportunity/Accommodation Plan” sent to System 504
Coordinator.
Date sent: ___________
IF NO, the child does NOT need an accommodation plan, the chairperson will:
___ Send the following to the parent (or if parent is present, make copies and give to parent):
Date sent:____________
___ “Parent/Guardian Notice of Section 504 Assessment Results” form. (n/a if parent present)
___ A copy of the “Section 504 Initial Disability Determination & Reevaluation” form.
___ Put originals of all forms in student’s 504 folder.
___ “Notice of Section 504 Protection” is placed in the student’s cumulative folder.
© 2015- Mary Moren
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If it is determined that the student IS NOT DISABLED and therefore not eligible for Section 504
protection, the 504 Chairperson will do the following:
___ Send the following to the parent (or if parent is present, make copies and give to parent):
Date sent:_____________
___ “Parent/Guardian Notice of Section 504 Assessment Results” form. (n/a if parent present)
___ A copy of the “Section 504 Initial Disability Determination & Reevaluation” form.
___ Put originals of all forms in student’s 504 folder.
If student is not eligible and the referral was specific to learning:
___ SST
should continue to monitor by staying in touch with teachers to assess the effectiveness of
the interventions, plan further interventions or make appropriate referrals.
© 2015- Mary Moren