SECTION 504 EVALUATION PLAN-RECOMMENDED ACCOMODATIONS/MODIFICATIONS
Student Name:
Birth Date:
Grade:
Teacher:
School:
Date:
PACING
ASSIGNMENTS
Adjust time for completion of assignment
Allow frequent breaks, vary activities often
Modify assignments requiring copying in a timed situation
Other: (Specify)
Other: (Specify)
ENVIRONMENT/SCHEUDLING
Define limits: _____Behavioral _____Physical
Reduce/minimize distractions: ____ Visual ____ Auditory
Leave class for assistance
Seat student near the teacher
Stand near student when giving directions or presenting lessons
Increase distance between desks
Provide consistent structure
Provide cooling off/break period
Adjust lighting
Adjust room temperature
Avoid distracting stimuli (air condition noise, high traffic area, etc.)
Other (specify):
Other (specify):
Other (specify):
LEGEND:  = Accommodation/Modification Attempted
Unsuccessful
Individual contracts
Give directions in small units; simplify complex directions
Use written back-up for oral direction
Lower reading level of assignment
Adjust length of assignment
Change format of assignment
Break assignment into series of small assignments
Reduce paper and pencil tasks
Read directions and/or worksheets to students
Record or type assignments
Maintain assignment notebook
Avoid penalizing for spelling errors
Block off or mask sections of work
Use highlighted texts
Use taped texts
Give extra time for assignments
Provide opportunity to respond orally
Provide study skills training/learning strategies
Hand out assignments one at a time
Require fewer correct responses to achieve grade
Use self-monitoring devices
Other (specify):
+ = Accommodation/Modification Successful
 = Accommodation/Modification to be Attempted
DISTRIBUTION:
 = Accommodation/Modification
Student cumulative folder; Parent/Guardian; Section 504 Liaison/coordination; Teacher; Other(s): _____________________
SECTION 504 EVALUATION PLAN-RECOMMENDED ACCOMODATIONS/MODIFICATIONS
Student:
PRESENTATION OF SUBJECT MATTER/MATERIALS
Use of computer aided instruction
Emphasize teaching: ___Auditory ___Visual ___Tactile ___Multi
Use individual/small group instruction
Utilize specialized curriculum
Tape lectures and texts for replay
Break longer presentations into shorter segments
Make sure directions are understood
Highlight critical information/key concepts on board
Pre-teach vocabulary
Provide organizers/study guides
Provide visual cues
Peer and cross-age tutoring; pair students to check work
Check often for understanding/review
Have student repeat directions
Emphasize study/organizational skills
Use repeated review/drill
Provide before or after school tutoring
Other: (specify):
BEHAVIOR MANAGEMENT
Request parent reinforcement
Clearly define limits
Give frequent reminders of rules
Maintain frequent eye contact
Hold private discussions regarding behavior
Keep classroom rules simple and clear
Create opportunities to help teacher
Supervise during transitions to other areas/activities
Ignore minor infractions
Implement behavior contract
Give reinforcement by praising specific behaviors/or use preferred
reinforcer
Place emphasis on student’s special talents
Implement secret signal between teacher and students
Initiate time outs
Ignore behaviors not drastically outside classroom limits
Allow legitimate movement
Other: (specify):
ASSESSMENT ADAPTATIONS
Give credit for projects
Give credit for class participation
Allow open book examinations`
Give take home tests
Adjust time for completion
Read test item to student
LEGEND:  = Accommodation/Modification Attempted
Unsuccessful
Give exam orally
Allow student to give test answers on tape recorder
Use modified format-more objective items, fewer essays responses
Give frequent short quizzes, not long exams
Reduce reading level
Other: (specify):
+ = Accommodation/Modification Successful
 = Accommodation/Modification to be Attempted
DISTRIBUTION:
 = Accommodation/Modification
Student cumulative folder; Parent/Guardian; Section 504 Liaison/coordination; Teacher; Other(s): _____________________
SECTION 504 EVALUATION PLAN-RECOMMENDED ACCOMODATIONS/MODIFICATIONS
Student:
ORGANIZATION
SPECIAL CONSIDERATIONS
Provide peer assistance with organized skills
Assign volunteer homework buddy
Allow student to have an extra set of books at home
Send daily/weekly progress reports home
Develop a reward system for in-school work and homework
completion
Other: (specify)
Suggest parenting program(s)
Monitor student closely on field trip
Arrange in-service training for other teachers on child’s handicap
Provide social skills group experiences
Develop intervention strategies for transitions (Cafeteria, P.E., etc.)
Alert bus driver
Suggest agency involvement
Provide group/individual counseling
Other: (specify)
Other: (specify)
MEDICATION
RELATED AIDS AND SERVICES
Name of physician:
Medications(s)/Schedule:
Specify/Name:
Medications(s)/Schedule:
Medications(s)/Schedule:
DICIPLINE (CHECK ONE)
Section 504 disability would not cause student to violate school rules
Section 504 disability could cause student to violate school rules. If
checked, complete Behavior Modification Disciplinary Plan or
Behavior Support Plan.
Other: (specify)
LEGEND:  = Accommodation/Modification Attempted
Unsuccessful
ADDITIONAL RECOMMENTATIONS
 Psycho-educational evaluation
 Accommodations/Modifications review scheduled on: (date)
 Section 504 Team Recommendation
Accommodations/Modifications mailed on: (date)
________________
+ = Accommodation/Modification Successful
 = Accommodation/Modification to be Attempted
DISTRIBUTION:
 = Accommodation/Modification
Student cumulative folder; Parent/Guardian; Section 504 Liaison/coordination; Teacher; Other(s): _____________________
SECTION 504 EVALUATION PLAN-RECOMMENDED ACCOMODATIONS/MODIFICATIONS
504 TEAM Participants:
Teacher: ________________________________________________
Parent: ________________________________________________
Other: _________________________________________________
Other: _________________________________________________
Other: _________________________________________________
Other: _________________________________________________
Other: _________________________________________________
Other: _________________________________________________
Other: _________________________________________________
Other: _________________________________________________
Other: _________________________________________________
Other: _________________________________________________
Administrator or 504 Coordinator: _____________________________________________