504 Forms and Brochures

Heartland AEA 11

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Heartland AEA 11
6500 Corporate Drive
Johnston, IA 50131
515/270-9030
800/362-2720

504 Brochures, Forms, and Resources

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504 Forms

Parent Consent to 504 Evaluation/ Rights (66KB) Parent Consent to 504 Evaluation (29 KB) Release of Information (Medical) (41 KB)	Form to obtain parental consent prior to evaluation for 504 eligibility and notice of parental rights. Department of Education release form modified with their consent to serve for Section 504. District letterhead may be placed at top of the forms.
Eligibility form Revised 2010 (49 KB) Eligibility form Revised 2010 (49 KB)	Latest form to determine eligibility.
Blank Form (123 KB) Blank Form without header (82 KB)	Sample form to write plan. Extra page to add to sample form without demographic information at the top.
Blank 504 Form (33 KB)	Sample form in a Word table format.
Teacher Input Form (53 KB)	Allows teachers to give meeting input without attending.
SAR Student Accommodation Request Form (For graduating students with 504 plans attending post secondary education.*) Directions to complete	Required form to enter post secondary education and receive accommodation consideration.

Iowa Department of Education Brochure and Guidance

Parental Rights Section 504 in Spanish (25 KB PDF)

Department of Education Guidance for Parents who Withdraw Children From Special Education and Demand Section 504 Plans (152 KB PDF)

January 2012 OCR/Department of Education Letter and Q & A for ADAA 2008

Heartland's Brochure and Other Resources

Section 504 Resources	Description
District and Student Checklist	Designed to be a memory jogger as to the required elements for districts on one side and the other side is meant to guide the student process from identification through eligibility determination and plan revision. Designed spring of 2011.
"A Guide to Section 504 of the Rehabilitation Act of 1973" Section 504 Brochure for parents and staff (217 KB PDF)	Often used by districts to notify parents of their rights under Section 504 and serve as Second Notice. Revised June of 2009.
Sample Accommodations List	Developed by Seiver County School System in Tennessee, this list is intended only to give ideas to 504 teams as to potential accommodations that may be useful. The list includes 25 medical conditions and general environmental, organizational, behavioral, presentation, and assessment strategies.

US Government Brochures

Students with Disabilities Preparing for Postsecondary Education: Know Your Rights and Responsibilities (online link *)	A 2002, updated in 2007, joint publication of the Department of Education and the Office of Civil Rights (OCR)
Frequently Asked Questions About Section 504 and the Education of Children with Disabilities (217 KB Word doc)	A publication of the OCR. Updated after ADA revisions in 2008.
Questions and Answers on the ADA Amendments Act of 2008 for Students with Disabilities Attending Public Elementary and Secondary Schools	A publication of OCR. Updated in January 2012. Provides insight on mitigating measures.
Accommodating Children with Special Dietary Needs (USDA) (872 KB PDF)	This is the source to answer questions related to Section 504 and school lunch accommodations.

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This web site is designed and maintained by MaryAnn T. Strawhacker R.N., B.S.N., M.P.H. Nurse Consultant AEA ll. Last revised 01/20/2012 © 2012 Heartland AEA ll