This form is used to request an evaluation of a student who has transferred to TSC with an active 504 Plan from another school. 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.

Email address *
General Information
Person Requesting Move-In Evaluation *
Student's First Name *
Your answer
Student's Last Name *
Your answer
Student's School *
Requested Information
Please email a copy of the Move-In 504 Plan to the District 504 Coordinator for review. This is required. A Move-In evaluation will not be conducted unless the student has an active 504 plan from another school.
Previous School's Name *
Your answer
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This form was created inside of Tippecanoe School Corporation.