Section 504: Forms, Related Documents, and Resources

Titles of forms and documents related to Section 504. Includes Section 504 Procedural Safeguards and the Section 504 Procedures Manual.

Designing 504 Plans to Promote Equity and Inclusion: Parents as Partners with Schools

A presentation on how parents and schools can work together through the 504 process. Presenters: Kathy Murphy, Section 504 Specialist, Donna Desaulniers, Manager, School Psychology Services, and Kristen Biernesser, Resource Counselor, School Counseling Services

Forms documenting the referral, evaluation, initial qualification, reevaluation, 504 Plan, and any causality hearings for a student considered for and/or qualified with a disability under Section 504 should be maintained in the student’s scholastic record.

SS/SE 92: Section 504 Procedural Safeguards

Used to communicate Section 504 Procedural Safeguards for parents.
Parents are provided a copy of the 504 procedural safeguards notice prior to evaluation, Child Find, identification, reevaluation, and/or placement.

SS/SE 281: Section 504 Meeting Notice

Used by FCPS staff to notify parents of an upcoming 504 meeting.
This notice is sent to parents prior to their child’s 504 Initial Qualification, 504 Plan, or 504 Reevaluation meeting.

SS/SE 79A: Consent to Exchange Confidential Student Information

SS/SE 85: Section 504 Qualification

SS/SE 86: 504 Plan

Used to identify that an FCPS student has qualified for an accommodation under Section 504.

The 504 Plan form is completed by the knowledgeable committee during a student’s 504 plan meeting. Accommodations, modifications, and/or services necessary to afford the student the equal opportunity to access school programs and activities are addressed with the 504 plan document.

SS/SE 86A: 504 Plan - Test Accommodations (Elementary School)

SS/SE 86B: 504 Plan - Test Accommodations (Middle School)

SS/SE 86D: 504 Plan - Test Accommodations (High School)

SS/SE 274: Read Aloud or Audio Accommodation Criteria Form

SS/SE 348: Special Permission Locally Awarded Verified Credit Accommodation (SPLAVC-A) Criteria Form

Additional Forms Related to Section 504

For more information on Section 504 forms or related documents please contact the Section 504 School Based Coordinator (SBC) at your school.   

  • 504 Plan Calculator Criteria Form (SS/SE-272)
  • 504 Plan Meeting Agenda (SS/SE-339)
  • 504 Plan Read Aloud or Audio Accommodation Form (SS/SE-274)
  • 504 Plan (Testing) Accommodations:
    • Elementary Accommodations (SS/SE-86A)
    • Middle School Accommodations (SS/SE-86B)
    • High School Accommodations (SS/SE-86D)
  • Consent to Exchange Confidential Student Information (SS/SE-79A)
  • Credit Accommodation Eligibility Form (SS/SE-353)
  • Local Screening Committee Report (SS/SE-14)
  • Multipurpose Referral (SS/SE-5, 5A)
  • Notice of Local Screening Meeting (SS/SE-83)
  • Notice Not to Evaluate (SS/SE-13)
  • Parent Information (SS/SE-127)
  • Parent Notice of Section 504 Causality Hearing (SS/SE-220A)
  • Section 504 Causality Hearing (SS/SE-220)
  • Section 504:  Parent Consent for Individualized Assessment (SS/SE-86G)
  • Section 504 Plan Credit Accommodations Eligibility Form (SS/SE-86H)
  • Section 504 Qualification (SS/SE-85)
  • Section 504 Transfer Student Documentation (SS/SE-86T)
  • Special Permission Locally Awarded Verified Credit Accommodation (SPLAVC-A) Criteria Form (SS/SE-348)
  • Student Audit Trail (SS/SE-8)
  • Student Observation (SS/SE-23)
  • Teacher Narrative (SS/SE-22)
  • Virginia Special Education Procedural Safeguards Requirement (SS/SE-4)

 

If a student transfers to another school within FCPS, the file is to be forwarded to the new school in accordance with regulations.

The student’s parent or guardian may examine his or her child’s educational record upon request (see Management of the Student Scholastic Record manual).

Additional Resources