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.
Person Requesting Re-Evaluation
Student's First Name
Student's Last Name
Please answer the following question as thoroughly as possible.
Reason for Request
Send me a copy of my responses.
Never submit passwords through Google Forms.
This form was created inside of Tippecanoe School Corporation.
Terms of Service