Date copy mailed to parent: _______________________


SECTION 504/ADA ACCOMMODATION PLAN

Student's Name: _____________________________________ Birthdate: ________________
School: ____________________________________________ Grade: __________________
Date of Meeting: ____________________________________ Review Date: _____________

1. Describe the nature of the concern: _____________________________________________
_____________________________________________________________________________
_____________________________________________________________________________

2. Describe the basis for the determination of handicap (if any): _________________________
______________________________________________________________________________
______________________________________________________________________________

3. Describe how the handicap affects a major life activity: ______________________________
______________________________________________________________________________
______________________________________________________________________________

4. Describe the reasonable accommodations that are necessary: __________________________
______________________________________________________________________________
______________________________________________________________________________

Those present (Name and title):
___________________________________       ___________________________________
___________________________________       ___________________________________
___________________________________       ___________________________________
___________________________________       ___________________________________
___________________________________       ___________________________________

I hereby acknowledge having been notified of my procedural rights under Section 504/ADA and having agreed to the contents of the plan.

___________________________________       ___________________________________
Parent's Signature Date

cc: Student's Cumulative File

Attachment: Information Regarding Section 504 of the Rehabilitation Act of 1973.

DATE ADOPTED: July 1, 2003