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
View the Presentation Page

 

 

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.

Section 504 Procedural Safeguards (SS/SE-92)

  • se92

    Section 504 of the Rehabilitation Act of 1973 Procedural Safeguards
    Parents are provided a copy of the 504 procedural safeguards notice prior to evaluation, Child Find, identification, reevaluation, and/or placement.

  • se92 (Arabic)

    Section 504 of the Rehabilitation Act of 1973 Procedural Safeguards (Arabic)

  • se92 (Chinese)

    Section 504 of the Rehabilitation Act of 1973 Procedural Safeguards (Chinese)

  • se92 (Farsi)

    Section 504 of the Rehabilitation Act of 1973 Procedural Safeguards (Farsi)

  • se92 (Korean)

    Section 504 of the Rehabilitation Act of 1973 Procedural Safeguards (Korean)

  • se92 (Spanish)

    Section 504 of the Rehabilitation Act of 1973 Procedural Safeguards (Spanish)

  • se92 (Urdu)

    Section 504 of the Rehabilitation Act of 1973 Procedural Safeguards (Urdu)

  • se92 (Vietnamese)

    Section 504 of the Rehabilitation Act of 1973 Procedural Safeguards (Vietnamese)

Section 504 Meeting Notice (SS/SE-281)

  • se281

    Notice of Section 504 Meeting
    This notice is sent to parents prior to their child’s 504 Initial Qualification, 504 Plan, or 504 Reevaluation meeting.

  • se281 (Arabic)

    Notice of Section 504 Meeting (Arabic)

  • se281 (Chinese)

    Notice of Section 504 Meeting (Chinese)

  • se281 (Farsi)

    Notice of Section 504 Meeting (Farsi)

  • se281 (Korean)

    Notice of Section 504 Meeting (Korean)

  • se281 (Spanish)

    Notice of Section 504 Meeting (Spanish)

  • se281 (Urdu)

    Notice of Section 504 Meeting (Urdu)

  • se281 (Vietnamese)

    Notice of Section 504 Meeting (Vietnamese)

Consent to Exchange Confidential Student Information (SS/SE-79a)

Section 504 Qualification (SS/SE-85)

504 Plan (SS/SE-86)

  • se86

    SS/SE-86 504 Plan
    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.

  • se86 (Arabic)

    504 Plan (Arabic)

  • se86 (Chinese)

    504 Plan (Chinese)

  • se86 (Farsi)

    504 Plan (Farsi)

  • se86 (Korean)

    504 Plan (Korean)

  • se86 (Spanish)

    504 Plan (Spanish)

  • se86 (Urdu)

    504 Plan (Urdu)

  • se86 (Vietnamese)

    504 Plan (Vietnamese)

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

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

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

Read Aloud or Audio Accommodation Criteria Form (SS/SE-274)

  • se274

    504 Plan Read Aloud or Audio Accommodation Criteria

  • se274 (Arabic)

    Read Aloud or Audio Accommodation Criteria Form - Arabic

  • se274(Chinese)

    Read Aloud or Audio Accommodation Criteria Form - Chinese

  • se274 (Farsi)

    Read Aloud or Audio Accommodation Criteria Form (Farsi)

  • se274 (Korean)

    Read Aloud or Audio Accommodation Criteria Form (Korean)

  • se274 (Spanish)

    Read Aloud or Audio Accommodation Criteria Form (Spanish)

  • se274 (Urdu)

    Read Aloud or Audio Accommodation Criteria Form (Urdu)

  • se274 (Vietnamese)

    Read Aloud or Audio Accommodation Criteria Form (Vietnamese)

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

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

  • Multipurpose Referral (SS/SE-5, 5A)
  • Notice of Local Screening Meeting (SS/SE-83)
  • Student Audit Trail (SS/SE-8)
  • Local Screening Committee Report (SS/SE-14)
  • Section 504 Qualification (SS/SE-85)
  • 504 Plan Meeting Agenda (SS/SE-339)
  • 504 Plan (Testing) Accommodations:
  • Elementary Accommodations (SS/SE-86A)
  • Middle School Accommodations (SS/SE-86B)
  • High School Accommodations (SS/SE-86D)
  • Section 504 Causality Hearing (SS/SE-220)
  • Parent Notice of Section 504 Causality Hearing (SS/SE-220A)
  • 504 Plan Read Aloud or Audio Accommodation Form (SS/SE-274)
  • 504 Plan Calculator Criteria Form (SS/SE-272)
  • Section 504 Plan Credit Accommodations Eligibility Form (SS/SE-86H)
  • Section 504 Plan Virginia Modified Achievement Standard Test (VMAST) (SS/SE-86V)
  • Section 504 Parent Consent for Individualized Assessment (SS/SE-86G)
  • Parent Information (SS/SE-127)
  • Teacher Narrative (SS/SE-22)
  • Student Observation (SS/SE-23)

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

View additional information on Section 504