Section 504 Accommodation Request Letter

Section 504 Accommodation Request Letter

Purpose

This template is used by parents, guardians, or eligible students (age 18+) to formally request evaluation for disability accommodations under Section 504 of the Rehabilitation Act of 1973. Section 504 is a federal civil rights law that protects students with disabilities from discrimination and ensures equal access to educational programs and activities.

Section 504 vs. IDEA (IEP)

Who Qualifies Under Section 504?

A student is eligible if they:

• Have a physical or mental impairment that substantially limits one or more major life activities (learning, reading, concentrating, thinking, communicating, walking, breathing, etc.)
• Have a record of such impairment, OR
• Are regarded as having such impairment

Examples include: ADHD, anxiety, depression, diabetes, asthma, food allergies, dyslexia, chronic health conditions, temporary impairments (broken limb), and more.

Section 504 Accommodation Request Letter Template

[Your Full Name]
[Your Street Address]
[City, State, ZIP Code]
[Your Email Address]
[Your Phone Number]

[Date]

[Principal's Name or 504 Coordinator's Name]
[School Name]
[School Address]
[City, State, ZIP Code]

Via Certified Mail, Return Receipt Requested

RE: Request for Section 504 Evaluation and Accommodations
Student Name: [Child's Full Name]
Date of Birth: [Child's DOB]
Grade: [Current Grade]
Student ID: [Student ID Number]

Dear [Principal's Name/504 Coordinator's Name]:

I am writing to formally request that [Child's Full Name] be evaluated for eligibility under Section 504 of the Rehabilitation Act of 1973 (29 U.S.C. Section 794). I believe my child has a disability that substantially limits one or more major life activities and requires accommodations to access the educational program.

Description of Disability/Condition

My child has been diagnosed with/experiences:

☐ Diagnosis/Condition: ________________________________________________

☐ Date of Diagnosis: ________________________________________________

☐ Diagnosing Professional: ________________________________________________

Impact on Major Life Activities

The condition substantially limits the following major life activities:

☐ Learning
☐ Reading
☐ Concentrating
☐ Thinking
☐ Communicating
☐ Writing
☐ Walking
☐ Breathing
☐ Seeing
☐ Hearing
☐ Eating
☐ Sleeping
☐ Standing
☐ Lifting
☐ Bending
☐ Working
☐ Caring for oneself
☐ Performing manual tasks
☐ Operation of major bodily function (specify: _____________)
☐ Other: ________________________________________________

Specific Impact on Education:
[Describe how the disability affects your child's ability to learn, participate, or access educational programs. Be specific about classroom challenges, assignments, testing, or participation issues.]

Current Challenges

My child is currently experiencing the following challenges at school:

1. [Describe specific challenge - e.g., difficulty completing timed tests]
2. [Describe additional challenge - e.g., trouble focusing during instruction]
3. [Describe other relevant impacts - e.g., frequent absences due to medical appointments]

Requested Accommodations

Based on my child's needs, I am requesting the school consider the following accommodations:

Instructional Accommodations:
☐ Preferential seating
☐ Extended time for assignments
☐ Reduced homework load
☐ Frequent breaks
☐ Modified assignments (not content, but format)
☐ Audio recordings of lectures
☐ Note-taking assistance
☐ Visual aids and graphic organizers
☐ Chunking of assignments into smaller parts
☐ Other: ________________________________________________

Testing Accommodations:
☐ Extended time (specify: ____% additional time)
☐ Separate/quiet testing location
☐ Breaks during testing
☐ Tests read aloud
☐ Use of calculator
☐ Use of computer/word processor
☐ Large print test materials
☐ Other: ________________________________________________

Environmental Accommodations:
☐ Seating away from distractions
☐ Access to water/snacks
☐ Permission to leave class for medical needs
☐ Climate-controlled environment
☐ Accessible furniture
☐ Other: ________________________________________________

Health-Related Accommodations:
☐ Medication administration during school hours
☐ Permission to carry medication (specify: ____________)
☐ Access to school nurse
☐ Modified physical education
☐ Elevator access
☐ Emergency action plan (for allergies, seizures, etc.)
☐ Other: ________________________________________________

Behavioral/Social-Emotional Accommodations:
☐ Positive behavior supports
☐ Check-ins with counselor
☐ Modified disciplinary procedures
☐ Social skills support
☐ Safe space/calm-down area access
☐ Other: ________________________________________________

Documentation Attached

I am providing the following documentation to support this request:

☐ Medical diagnosis/physician letter
☐ Psychological or psychoeducational evaluation
☐ Previous 504 Plan (from prior school)
☐ Previous IEP (if applicable)
☐ Report cards/progress reports
☐ Teacher observations/communications
☐ Specialist reports (specify: _____________)
☐ Other: ________________________________________________

Request for Written Policies

Pursuant to Section 504 regulations, I am also requesting:

☐ A copy of the district's Section 504 policies and procedures
☐ A copy of parent/student rights under Section 504
☐ Information about the 504 evaluation process and timeline

Request for 504 Evaluation Meeting

I request that the 504 team convene to evaluate my child's eligibility within a reasonable timeframe. Please contact me at [phone number] or [email address] to schedule the evaluation meeting.

I understand that the school will gather information from multiple sources, which may include:

• Teacher feedback and observations
• Grades and assessment data
• Medical documentation
• Parent input
• Classroom performance data

I am committed to working collaboratively with the school to ensure my child receives the support needed to access their education.

Please confirm receipt of this request in writing within 10 business days and provide me with the proposed timeline for the evaluation process.

Thank you for your prompt attention to this matter.

Sincerely,

_________________________________
[Your Full Name]
Parent/Guardian of [Child's Full Name]

Enclosures Checklist

☐ Medical documentation/diagnosis letter
☐ Psychological evaluation (if available)
☐ Treatment records
☐ Previous 504 Plan or IEP
☐ Report cards
☐ Teacher communications
☐ Other: ________________________________________________

The Section 504 Process

Step 1: Referral

• Parent, teacher, or other staff member refers student for evaluation
• Written request recommended

Step 2: Evaluation

• School gathers information from multiple sources
• No parental consent required for evaluation (unlike IDEA), but recommended
• Evaluation must be completed in reasonable timeframe

Step 3: Eligibility Determination

• 504 team (including parent) reviews information
• Determines if student has qualifying disability
• No single test or criterion can be sole basis for eligibility

Step 4: Plan Development

• If eligible, 504 team develops accommodation plan
• Plan specifies accommodations and responsible parties
• Parent receives copy of plan

Step 5: Implementation and Review

• Teachers implement accommodations
• Plan reviewed periodically (typically annually)
• Re-evaluation before any significant change in placement

Parent Rights Under Section 504

• Right to receive notice of school actions regarding your child
• Right to examine relevant records
• Right to an impartial hearing with representation by counsel
• Right to review evaluation procedures and data
• Right to file a complaint with the Office for Civil Rights (OCR)

If Your Request Is Denied

1. Request Written Explanation: Ask for written reasons for the denial
2. Request Reconsideration: Provide additional documentation
3. File Internal Grievance: Use district's grievance procedure
4. File OCR Complaint: Contact the U.S. Department of Education Office for Civil Rights
   - File within 180 days of the discriminatory action
   - Online: www.ed.gov/ocr/complaintintro.html
   - Phone: 1-800-421-3481

State-Specific Notes

While Section 504 is federal law, implementation may vary by state and district:

Resources

• U.S. Department of Education Section 504: ed.gov/laws-and-policy/individuals-disabilities/section-504
• Office for Civil Rights: ed.gov/ocr
• Parent Guide to Section 504: Available from your school district
• Understood.org Section 504 Resources: understood.org

Disclaimer

This template is provided for informational purposes only and does not constitute legal advice. Section 504 procedures may vary by school district. Consider consulting with a disability rights advocate or attorney for guidance specific to your situation.