Section 504 Process Checklist
“Parent/Guardian (or Majority Age Student) Request”
NOTE: Section 504 forms are available on the Special Services Department
“internal” website – access through Inside Parkway “Resources.”
____ Document the date of and basis for the parent/guardian (or majority age student) request on the
“Section 504 Referral/Evaluation Review” form.
NOTE: If the parent/guardian (or majority age student) is NOT ruling out consideration of the
Individuals with Disabilities Education Improvement Act (IDEA), use IDEA compliance
procedures, 30 day time line, and the “Joint Review” process (i.e., Joint Review Letter
followed by an SSD Notice of Action).
____ Complete and send Parkway’s “Section 504 Referral/Evaluation Review” form to the
parent/guardian (or majority age student) and place a copy in the student record.
NOTE: In nearly all situations, check:
“More information is needed before a final determination can be made
regarding the need for a Section 504 evaluation. When sufficient information is
available, a determination will be made and you will be notified of any decisions
made. In the interim, the student will be considered to have a SUSPECTED
disability and be provided with appropriate protections, supports, and/or
interventions under Section 504.”
Describe what documentation and/or data school staff will collect/analyze and what, if any,
information/documentation is requested from the parent/guardian (or majority age student).
When sending this document, include:
 Parkway’s Section 504 “Parent/Student Rights Regarding Identification, Evaluation, And
Placement”
 “Section 504 of the Rehabilitation Act of 1973” handout
 “Authorization For Release of Information” form (#287) to ensure all private documentation is
obtained and considered (IF NEEDED/APPLICABLE)
____ Document that the student is SUSPECTED of having a DISABILITY with a copy of the “Section
504 Referral/Evaluation Review” form in the student’s education record.
____ Notify all appropriate staff of the student’s status as student with a SUSPECTED disability.
___ school counselor
___ school administrators
___ registrar - documents the student’s status on the District’s student information system
(Infinite Campus)
___ school nurse
___ student’s teachers
___ other(s) ____________________________________________________
____ Identify/notify a staff member who will serve as the “interim” case manager.
____ Plan, document, and provide appropriate and needed supports/interventions and accommodations
during the interim and until final determinations are made.
NOTE: An “Interim Suspected Disability Plan” form can be used if an intervention/support plan is
2/7/12
NOT already developed and in place through another process (i.e., Care Team).
2/7/12
Section 504 Process Checklist
“Parent/Guardian Request” (cont.)
____ Request and COLLECT all relevant documentation, data, and other information needed to address
the suspected disability. These might include:
o Parent Contact Form
o Teacher Information Form(s)
o standardized assessment data
o work samples
o previous public school evaluations
o evaluations/reports from private professionals
o documentation of the diagnosed impairment(s)
o other checklists and documentation applicable to the area(s) of concern
NOTE: This step may require signed releases from the parent/guardian (or majority age student)
and need to be repeated at various times during the “identification” process.
NOTE: If student is majority age and living with parent/guardian, include parent/guardian with all
communication.
____ A “multidisciplinary’ school team (i.e., Care Team) REVIEWS all relevant information,
documentation and data about the student, his /her impairment, and any major life activity/activities
that may be adversely affected/substantially limited.
NOTE: EVIDENCE of a MENTAL OR PHYSICAL IMPAIRMENT MUST be present for a student
to be considered for (i.e., suspected of having) a disability under Section 504.
____ A “multidisciplinary’ school team (i.e., Care Team) DETERMINES whether the student is
SUSPECTED of having a disability under Section 504.
IF SUSPECTED of having a disability, determine whether to refer for an evaluation to determine
eligibility NOW or whether more information is needed before making a final decision.
The “Section 504 Referral/Evaluation Review” process must conclude with one of four decisions:
 An evaluation to determine eligibility under Section 504 will be conducted.
NOTE: The Office for Civil Rights (OCR) REQUIRES an evaluation PRIOR to determining a
student has a disability under Section 504 (a mental or physical impairment that
substantially limits a major life activity).
 No disability is suspected and no Section 504 evaluation will be conducted.
 More information continues to be needed before a final determination can be made regarding
the need for a Section 504 evaluation. The student will continue to have a SUSPECTED disability
under Sections 504 until a further determination is made and, in the interim, be provided with
appropriate protections, supports, and/or interventions.
 A referral for Section 504 will not be made as requested, but a referral for an IDEA/special
education evaluation will be considered instead.
NOTE: If the team suspects the student has a disability under the Individual’s with Disabilities
Education Improvement Act (IDEA), the school’s Care Team should consider a special
education referral/evaluation; a Special School District representative must participate in such
determinations. The parent/guardian (or majority age student) shall be notified of the decision
by Special School District using the “Joint Review Letter” and provided with the procedural
safeguards under both laws. To be eligible under the IDEA, a student must meet the
2/7/12
categorical criteria for an educational disability AND need special education services in order
to access and benefit from their education.
2/7/12
Section 504 Process Checklist
“Parent/Guardian Request” (cont.)
___ NOTIFY the parent/guardian (or majority age student) of the decision. If referring for evaluation or
dropping the suspected disability, use the “Section 504 Referral/Evaluation Review” form and
provide the appropriate procedural safeguards.
____ Place a copy of the “Section 504 Referral/Evaluation Review” form in the student’s education record.
____ Notify all appropriate staff of the decision so they know the student’s status.
___ school counselor
___ school administrators
___ registrar - documents the student’s status on the District’s student information system
(Infinite Campus)
___ school nurse
___ student’s teachers
___ other(s) ____________________________________________________
WHEN A STUDENT WILL BE EVALUATED UNDER SECTION 504
____ Submit a referral packet (available on website) to the Parkway Special Services Department.
NOTE: Parkway’s Special Services Department and/or Health Services
Department shall participate in ALL Section 504 evaluations,
including those that MAY be “expedited.”
____ A Special Services Department staff member will contact the school (i.e., case manager) to review the
referral information, coordinate the evaluation, and participate in the eligibility determination.
Special Services staff will coordinate the evaluation and ensure that:
o
consent for evaluation is obtained from the parent/guardian (or majority age student) once an
evaluation “plan” is developed
NOTE: Consent for evaluation is REQUIRED PRIOR to any evaluation to determine
eligibility. IF CONSENT IS REFUSED, document the refusal in the student’s
education record and code the student as “non-disabled” on the District student
information system. A “refusal to consent to evaluation” letter should be sent to
document the refusal.
o
appropriate “releases” and additional third party information are obtained when needed
o
a multidisciplinary team, which should include the parent/guardian and student (if appropriate),
meets, reviews the evaluation information, and determines if the student meets criteria for
eligibility under Section 504.
NOTE: Evaluation MAY include: direct assessment (i.e., testing, self-report scales) of the student,
rating scales completed by staff and/or parent/guardian, collection and consideration of
school/classroom documentation, collection and consideration of “third party” documentation,
and/or other activities. Evaluation may address the student’s impairment, limitation(s), and/or
need for intervention/supports and/or accommodations.
2/7/12
Section 504 Process Checklist
“Parent/Guardian Request” (cont.)
WHEN A STUDENT IS ELIGIBLE UNDER SECTION 504
____A multidisciplinary team determines what, if any, accommodations (i.e., interventions, supports,
modifications, adaptations) are needed to provide the student with a free appropriate public education
(FAPE). The student must be able to access and benefit from the general education program to an extent
comparable to that of his/her (average) peers.
When a student is eligible under Section 504, several scenarios/situations are possible:

The student is CURRENTLY accessing and benefiting with the “universal” instruction,
natural supports, and standard services available/provided to all students. For example, the
student has “mitigating measures” (i.e., medication, hearing aid) in place that are effectively
eliminating the substantial limitation(s) and need for accommodations OR the impairment is
currently in remission/not active (i.e., episodic).
o A Section 504 plan is NOT NEEDED, BUT the appropriate documentation is needed on the
“determination” (eligibility) form.
o The school must respond and develop an appropriate Section 504 plan if the student’s status
changes and there is a need for accommodations because of the impairment(s).

The student REQUIRES additional supports, interventions and/or a specialized health care
plan in order to access and benefit from the general education program, BUT these are NOT
SIGNIFICANTLY DIFFERENT from what students without disabilities may receive.
o A separate, individualized Section 504 plan is OPTIONAL, but the specific
supports/interventions and/or health care plan MUST BE DOCUMENTED in the student’s
education and/or health record and noted on the “determination” (”eligibility”) form.
o The student’s needs and school’s responsibilities must be communicated to appropriate staff.
o The school must respond and develop an appropriate plan if there is a need for individualized
accommodations because of the impairment(s).

The student REQUIRES individually planned and implemented accommodations (i.e.,
modifications, adaptations, services, supports) in order to have access to and benefit from the
general education program.
o A separate Section 504 plan MUST BE DEVELOPED with individualized accommodations
to document what is needed to address the impact of the impairment(s) and provide a free
appropriate public education (FAPE).
o The student’s needs and school’s responsibilities must be communicated to appropriate staff.
____ Notify all appropriate staff on a need to know basis, of the student’s status and, when applicable, the
accommodations, supports, interventions, and/or health care plan to be provided.
___ school counselor
___ school administrators
___ registrar - documents decision on the District’s student information system (Infinite Campus)
___ school nurse
___ student’s teachers
___ other(s) ____________________________________________________
____ Annually review an eligible student’s needs and status. When appropriate, initiate team meetings to
review/revise the plan and/or reevaluate the student.
NOTE: Copies of CURRENT Section 504 documents are kept in the student’s cumulative folder.
Older/expired Section 504 documentation should be kept in the student’s Class 2 file.
2/7/12