504 Plan Basic Info. Sheet

Student:  ________________________________

Class:  ___________________________________

Diagnosis for student is:  _________________________________

An annual 504 Meeting will be held:  _________________________

District Testing Accommodations:

None                                Extended Time                                Other

SBAC Accommodations:

None                                Small Group                Other

Any Special Services or Behavior Plan Required:

Please see attached plan for your student, especially “Accommodation Plan”, which outlines what accommodations should be taking place.  All special area teachers will receive a copy of that page.

Please let me know if you have any questions.  Thank you!!