504 Complaint Form

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504 Complaint Form

Section 504 of the Rehabilitation Act of 1973 is a federal law that prevents discrimination against students with disabilities. Under this provision, any school that receives federal funding must make accommodations to ensure that all students with disabilities are guaranteed a free public education. A 504 plan refers to the methods and strategies designed by teachers, parents, and administrators to comply with this law. This form is for any complaints that you may have regarding your child's 504 plan or 504 eligibility.

Email *

Name of Person Filing Complaint (Last, First, M.I.) *

Phone Number (Include Work Phone Number) *

Student's Name and Grade Level *

Student ID Number (optional)

Name of School Site *

Nature of Complaint: *

504 plan not being followed.

Disagreement about accommodations.

504 plan not working for my child.

Request for 504 Eligibility Meeting not being honored at the school site.

Other:

Describe, in detail, the nature of complaint: *

Have you tried to resolve your complaint with your School Administrator(s)? *

Yes

If Yes, Who Did You Speak To? (Name, Job Title, Date of Discussion and What Was the Result of the Discussion?) *

What Would You Like to Happen As A Result of This Complaint?

I understand that a copy of this complaint will be given to the Coordinator of 504 services, and I will receive call/email response within 48 hours in an effort to resolve the complaint. *

Yes

Required

Signature: Please write Full Name and Date *

Send me a copy of my responses.

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