Section 504 Manifestation Determination Report

Date:

Name: / Enter student last, first name / School: / Select a schoolBeardsley Elementary-1765Mary Beck Elementary-1769Bristol Elementary-1693Cleveland Elementary-1617Mary Daly Elementary-1773Eastwood Elementary-1679Mary Feeser Elementary-1681Hawthorne Elementary-1777Monger Elementary-1789Osolo Elementary-1673Pinewood Elementary-1785Riverview Elementary-1797Roosevelt Elementary-1801Woodland Elementary-1817North Side Middle School-1753Pierre Moran Middle School-1763West Side Middle School-1761Central High School-1749Memorial High School-1750Jr Life Alternative-1751Life Alternative-1751Pace Preschool-1811Student Services-77
Birth date: / Grade: / Enter current grade
Parent(s): / Enter parent name / ID #:
Address: / Enter current address / Phone/cell#: / Enter parent contact phone #
Section 504 coordinator: / Enter name / Phone: / Ente coord. phone #
Date of meeting: / 504 Disability:

Purpose of Meeting

The purpose of this meeting is to determine if the student’s misconduct was a manifestation of the student’s Section 504 disability. It is not an opportunity to dispute whether the misconduct actually occurred or what disciplinary action is appropriate. (These issues can be resolved in other forums).

Agenda

Description of misconduct:

It is appropriate to have the building administrator provide this information based on personal knowledge and discipline notices sent to the parents form the school. The description should be as thorough and detailed as possible:

Note: The district may take disciplinary action pertaining to the use or possession of illegal drugs or alcohol against a student who is an individual with a Section 504 disability and who is currently engaging in the illegal use of drugs or alcohol to the same extent that such disciplinary action is taken against student without disabilities. Under such circumstance, administrators should consult with Mary Jo Sartorius, special education administrator or W. Douglas Thorne, director of employee and student relations.

Analysis:

Review the relevant information in the student’s file, including information from parents, any teacher observations, and the student’s Section 504 Plan.

·  Was the misconduct for which the district seeks to discipline the student either caused by, or does it have a direct and substantial relationship to the student Section 504 disability? Yes No

·  Was the misconduct for which the district seeks to discipline the student a direct result of the failure to implement the current Section 504 Plan? Yes No

If the answer to either of the above questions is yes, the misconduct is a manifestation of the student’s educational disability. If the answer to both questions is no, then the misconduct is not a manifestation of the student’s education disability.

Conclusion of the manifestation determination:

Please provide a precise and well-reasoned summary explaining why the team found that the misconduct was or was not a manifestation of the student’s education disability:

Next steps (as appropriate):

I.  If the student’s misconduct is a manifestation of the student’s disability, the Section 504 team must:

a.  Withdraw the recommendation to expel, to long-term suspend, or to impose any other disciplinary change of placement.

b.  Review the student’s behavior plan. If there is no plan, consider drafting one.

c.  Return the student to the placement from which the student was removed (unless the parent and the district agree to a change in placement).

d.  Discuss whether any changes to the student’s Section 504 Plan are appropriate.

II.  If the student’s alleged misconduct is not a manifestation of the student’s disability, the student may be disciplined in the same manner as non-disabled students.

Participants

Printed name Title Signature

Section 25.7 Page 1 of 2 Elkhart Community Schools

Revision 1/2011 Student Services Department