Brownsville Independent School District s4

Brownsville Independent School District

Section 504

Student: ID#: DOB: Gr.: Campus:

Notification to Parents of §504 Evaluation [F-1]
Purpose of Notice:
Date: / Initial §504 Meeting / §504 Yearly Update
§504 Revision / Manifestation Determination
Parent’s Name:

This letter provides you with written notice that your child has been referred to the campus §504 Committee to determine if your child has a qualifying disability under Section 504 of the Rehabilitation Act. An evaluation will be performed to determine initial§504 eligibility or continued §504 eligibility. The nature of the concern may be due to one of the following:

Mental Impairment / Physical Impairment / Health-Related Impairment
Specify Condition/Disability (if known):

In many cases, the §504 evaluation will consist of the campus §504 Committee reviewing and interpreting existing school records, including anecdotal evidence, observations, prior testing, grades, standardized test scores (i.e., state assessments, TPRI/Tejas LEE, etc.), and other available data, in order to determine if your child qualifies for accommodations in the regular classroom. For students who have been involved in the Response to Intervention process, the §504 evaluation will include a review of the classroom assistance and interventions previously provided, the results of those efforts, and any other data generated by that process. This is NOT a referral to Special Education.

In addition to reviewing the data described above, the district desires to conduct the following evaluation to determine if:

Student exhibits characteristics of Dyslexia / Not Applicable

The law establishes that school personnel are responsible for the identification, evaluation, and placement of eligible students under Section 504 Regular Education. (Letter to Mentink, 19 IDELR 1127). In addition, the law establishes that parents and other outside contributors of evaluation information (such as physician reports and/or recommendations) should be considered, but are not in and of themselves the deciding factor for eligibility. As the law places the burden of evaluation and placement solely on the educational institution, it does not require parental presence at §504 decision-making meetings. [Edmund (OK) School District, 31 IDELR 242 (OCR 1999)].

As parents and/or legal guardians, you are requested to provide information for consideration by the campus §504 Committee including any insights and/or contributions (i.e., doctor’s reports, outside evaluations, etc.) that would be helpful to the committee in making the best evaluation and placement decisions possible. To assure that the §504 Committee considers your insights and information regarding your child, please contact:

(Name of person to be contacted) / at
(Telephone #) / before .
(Date)

The §504 Committee will meet on (date) in Room at A.M./P.M. to discuss your child’s educational needs.

Notification to Parents of §504 Evaluation [F-1]

If your child is determined to be qualified and eligible under Section 504, the campus §504 Committee will develop an individual accommodation plan (IAP) to address your child’s educational needs.

For your information, we have attached a copy the Notice of Parent and Student Rights Under Section 504 of Rehabilitation Act of 1973. Please indicate your receipt of this notice by completing and returning the attached Section 504 Receipt for Rights Notice.

If this is a notice for an initial §504 meeting, you will also find attached a copy of A Parent’s Guide to Section 504 of the Rehabilitation Act of 1973 and a copy of the Parental Consent for the Initial §504 Evaluation and Placement. Please review and sign your consent or dissent and return with the Receipt for Rights Notice.

If you have any questions concerning this notice, the evaluation process, and/or §504, please contact your campus §504 Coordinator.

______
Signature of Campus §504 Coordinator / Telephone #:
______
Signature of Interpreter

* * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * *

For Completion by Campus:

§504 Notification to Parents (F-1), §504 Parent Right (F-2), §504 Parent Consent (F-3), and §504 Parent Receipt for Notice and Rights (F-4) should in most situations be presented to parent(s) in person. If notice is being provided for an Initial Referral to Section 504, a copy of the §504 Parent Guide should also be provided.
Date provided to parent: .
If parent is not available in person within a reasonable amount of time (not to exceed 14 calendar days from date of notice to parent), campus shall either mail the above documents or deliver to parent in person.
Date mailed to parent: .
OR
Date delivered to parent: . Received by:
Notice of Parent and Student Rights Under
§504 of the Rehabilitation Act of 1973 [F-2]

The Rehabilitation Act of 1973, the Section commonly referred to as “504", is a non-discrimination statute enacted by the United States Congress. The purpose of this section of the Act is to prohibit discrimination against individuals with disabilities and to assure that disabled students have educational opportunities equal to, but not necessarily identical to, those provided to non-disabled students.

To qualify for protection under Section 504, an eligible student is one who (1) currently has; (2) has a record of having; or (3) is regarded as having a physical or mental impairment which substantially limits one or more major life activity such as (but not limited to) seeing, hearing, speaking, breathing, self-care, walking, performing manual tasks, working, reading, thinking, concentrating, learning and/or major bodily functions.

The regulations for Section 504 are set out in 34 C.F.R. Part 104 and provide eligible students with the following rights:

1. An appropriate education designed to meet his/her individual educational needs as adequately as the needs of non-disabled students are met.

2. Free educational services except for those fees that are imposed on non-disabled students or their parents.

3. Placement in the least restrictive environment.

4. Facilities, services, activities and programs that are comparable to those provided for non-disabled students.

5. An evaluation prior to an initial Section 504 placement and any subsequent significant change in placement based on evaluation information that comes from a variety of sources.

6. Placement decisions made by a group of persons, including persons knowledgeable about your child, the meaning of the evaluation data, and appropriate placement options.

7. Periodic re-evaluations.

The regulations for Section 504 are set out in 34 C.F.R. Part 104 and provide the following parental/legal guardian rights:

1. Receive notice regarding the identification, evaluation, and/or placement of your child.

2. Examine relevant records pertaining to your child.

3. Request an impartial hearing with respect to the district’s actions regarding the identification, evaluation, or placement of your child, with an opportunity for the parent/guardian to participate in the hearing, to have representation by an attorney, and have a review procedure.

4. File a complaint with the District Section 504 Coordinator at (956) 546-8679, who will investigate the allegations regarding Section 504 matters other than your child’s identification, evaluation, and placement. For matters regarding your child’s identification, evaluation, and/or placement, call your campus §504 Coordinator, (Name, Phone #).

5. File a complaint with the regional Office for Civil Rights for the State of Texas.

Office for Civil Rights

Southern Division, Dallas Office

1999 Bryan Street, Suite 2600

Dallas, TX 75201

(214) 880-2459

Parental Consent for the Initial
§504 Evaluation and Placement [F-3]

As the parent/legal guardian of the above referenced student, having received notice of my §504 parent rights, I hereby:

Give my consent for the initial evaluation and placement under §504 Regular Education.

I understand that this is NOT a referral for a Special Education evaluation.

Do NOT give my consent for the initial evaluation and placement for §504 Regular Education.

Date / ______
Signature of Parent/Legal Guardian / Printed Name of Parent/Legal Guardian
______
Signature of Interpreter

FOR SCHOOL USE ONLY:

Parent could not be present to sign permission for initial evaluation and placement for Section 504 Regular Education learning-related, behavior-related, and/or health-related services. Parental Consent for the Initial Evaluation and Placement, was mailed or provided in person to the parent/legal guardian. Seven (7) working days have passed. Parent(s)/legal guardian did not respond in writing or by oral consent/dissent. Therefore, the §504 committee concludes parental consent by omission.

§504 Notification to Parents (F-1), §504 Parent Right (F-2), §504 Parent Consent (F-3), and §504 Parent Receipt for Notice and Rights (F-4) should in most situations be presented to parent(s) in person. If notice is being provided for an Initial Referral to Section 504, a copy of the §504 Parent Guide should also be provided.
Date provided to parent: .
If parent is not available in person within a reasonable amount of time (not to exceed 14 calendar days from date of notice to parent), campus shall either mail the above documents or deliver to parent in person.
Date mailed to parent: .
OR
Date delivered to parent: . Received by:
Receipt for Parent and Student Rights Notice [F-4]

This is to verify that I have received a copy of the Notice of Parent and Student Rights Under §504 of the Rehabilitation Act of 1973, which informs me of my rights and those of my child. I understand that my rights include the following:

1. The right to receive written notice in the language I understand (primary language) or, if needed, a translation of such orally, in sign language, or in Braille;

2. The right to receive answers from school personnel to additional questions that I may have; and

3. This is NOT a referral for a Special Education evaluation.

My signature below indicates that I have received the notice and understand its contents.

Date / ______
Signature of Parent/Legal Guardian / Printed Name of Parent/Legal Guardian

Please return this notice to the campus §504 Coordinator.

______
Campus §504 Coordinator / Telephone #:

For Completion by Campus:

Directions: Use this form to record any parental input from telephone conversations and/or parent conference exclusive of any §504 committee meetings. Parental input is to be obtained prior to developing an initial §504 IAP, yearly updates, revisions and/or manifestation determinations. This includes evaluations for dyslexia and/or revisions.

Date:

Areas of Concern:

Does Student Have any Mitigating Measures? Yes No

If “Yes”, Explain What the Mitigating Measure Involves:

Discussion:

Input received via Parent Conference / Input received via Telephone Conversation
______
Parent Signature / Date / Date / Time
______
Teacher Signature / Date / ______
Teacher Signature / Date
Record of Minutes for §504 Committee [F-6]
Directions: / Use this form to record any §504 Committee meeting discussion. Minutes should be kept by the §504 Committee from the initiation of the §504 process and at every subsequent meeting held to discuss, review and/or update a student’s eligibility and/or IAP. A separate page should be used for each meeting. Minutes are required.
Reason for Meeting:
Date: / Initial §504 Eligibility / §504 Yearly Update
§504 Revision / Manifestation Determination

Evaluation and Eligibility Documentation:

I. Review of Available Information (include test scores when appropriate)

1. Summarize present levels of performance in areas evaluated.

2. Teacher reports/comments: (Information provided should be educationally relevant. RtI data to also be considered.)

3. Areas of concern: (i.e., behavior, academic, dyslexia, medical – Be specific)

4. Health and development: (include information available from school nurse and/or parent – must be current)

5. Data reviewed and/or considered: check all that apply – a variety of data is required.

Samples of student work
Student profile
Health/medical report
Parent information
Formal tests (aptitude, etc.)
Teacher recommendations
and/or observations / Grades
Results of Speech screening
Cumulative folder (copy)
Discipline records (copy)
Progress reports
State assessment reports (copy) / Anecdotal reports
Adaptive behavior checklists
Individualized reading tests
Learning style inventories
Sped. Educ. FIE report
(copy/summary)
Other:

6. Further information needed? Yes No

(a) If Yes, what information is needed?

(b) Person responsible for obtaining information:

Eligibility Discussion: As directed by Congress in the ADAAA, the Section 504 Committee understands that the definition of disability “shall be construed in favor of broad coverage of individuals under this Act, to the maximum extent permitted by the terms of this Act.” Based on the evaluation data that has been gathered from a variety of sources, the §504 Committee answered the following questions to determine the student’s §504 eligibility:

Yes / No / 1. / Does the student have a mental or physical impairment? If “Yes,” check the impairment. §504 regulations at 34 CFR §104.3(j)(2)(i) define a mental or physical impairment as any physiological disorder or condition, cosmetic disfigurement, or anatomical loss affecting one or more of the following body systems. Note: This is an educational determination only and not a medical diagnosis for purposes of treatment.
Neurological / Respiratory / Endocrine / Hemic/Lymphatic
Musculoskeletal / Cardiovascular / Skin / Genito-Urinary
Reproductive / Digestive / Speech Organs / Special Sense Organs
Mental or Psychological Disorders (does NOT include “slow learners”) such as:
Mental Retardation / Organic Brain Syndrome / Emotional Illness
Mental Illness / Dyslexia / Specific Learning Disabilities
Other: / Other: / Other:
Yes / No / 2. / Does the mental or physical impairment affect one or more major life activities? If “Yes,” check which major life activity or activities are affected. To fall within the protection of §504, a student’s mental or physical impairment must have a substantial limitation (permanent or temporary – at least 6 months) on one or more major life activities, including but not limited to:
Walking / Hearing / Learning – (not slow learner) / Communicating
Talking / Speaking / Caring for one’s self / Concentrating
Seeing / Breathing / Performing manual tasks / Reading
Bending / Sitting / Eating / Lifting
Major bodily functions, including but not limited to:
The immune system / Bladder function / Respiratory function
Digestive function / Neurological function / Circulatory function
Normal cell growth / Brain function / Endocrine function
Bowel function / Reproductive function / Other:
Yes / No / 3. / Does the mental or physical impairment Substantially Limit a major life activity? That is, as a result of the mental or physical impairment, is the student substantially limited as to the condition, manner or duration under which the student can perform a particular major life activity when compared to their same age non-disabled peers? Note: In making the determination of substantial limitation, the ADAAA requires that the Committee should NOT consider the ameliorative effects of mitigating measures (except for ordinary eyeglasses or contact lenses). The fact that the impairment is episodic (the impact of the impairment is sometimes substantially limiting, but not always), or in remission, does not preclude eligibility if the impairment would substantially limit a major life activity when active.
Use the following questions ONLY to support the §504 Committee’s determination of a substantial limitation:
On district outcome assessments, are student’s skills markedly below average and not the result of being a “slow learner”?
On grade reports, is there an overall pattern of poor grades? (reflecting both strengths and weakness)
On group-administered standardized achievement tests, does student score below average?
Has student received disciplinary action for inappropriate behavior on a regular basis?
Does student have special health care needs (i.e., medication, allergy, etc.) during class activities, including lunch?
Does student have a pattern of excessive absences not due to truancy and/or tardies?
Other: (specify)
Yes / No / 4. / Does the student need Section 504 accommodations in order for his/her educational needs to be met as adequately as those of non-disabled peers? Note: If the student’s needs are so extreme as to require special education and related services, a referral to special education should be considered. If the student’s impairment is in remission, or the student’s needs are currently met by mitigating measures, the student is not in need of a Section 504 Accommodation Plan and is not eligible for FAPE.
1. If all four questions were answered “Yes,” the student is eligible for both the nondiscrimination protections of Section 504 and a free, appropriate public education under §504. The §504 Committee will create an individual accommodation plan (IAP) for this student.
2. If only the first three questions are answered “Yes”, the student is eligible for the nondiscrimination protections of Section 504, but the §504 Committee will NOT create an Individual Accommodation Plan at this time as the student’s needs are being met as adequately as his nondisabled peers.
3. If any of the four questions were answered “No,” the student is NOT eligible for the nondiscrimination protections of Section 504 and is NOT eligible for a §504 Individual Accommodation Plan. Student shall be referred back to the RtI process for consideration of continued interventions through the RtI process.

Eligibility Decision: