This form is used to request a student be re-evaluated to determine continued eligibility under Section 504, to reconsider eligibility for a student evaluated within the last year and found not eligible, or when a significant change in placement is being proposed for a student with a current 504 plan. If one of these apply, please complete the form below
Once the form is completed, the District 504 Coordinator will process the request in a timely manner.
If you have any questions about this process, please contact your school's 504 Designated Person.
* Required
Email address
*
Your email
General Information
Person Requesting Re-Evaluation
*
Choose
Parent
Teacher
Counselor
Administrator
Nurse
Other
Student's First Name
*
Your answer
Student's Last Name
*
Your answer
Student's School
*
Choose
BGE
BCE
CES
DES
HES
KE/IS
MME
MES
WRE
WES
WYE
BGM
ETM
KMS
SMS
WMS
WRM
HHS
MHS
Requested Information
Please answer the following question as thoroughly as possible.
Reason for Request
*
Your answer
Send me a copy of my responses.
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