Haxtun School District Special Education Teachers

Jessica Oliver   jessicaoliver@haxtunk12.org

Becky Williams   beckywilliams@haxtunk12.org

Haxtun School District 504 Coordinator:  Jessica Hofmeister

jessicahofmeister@haxtunk12.org

504 Referral Form

Step 1: Identification - 3 Criteria

1. The student must have a mental or physical impairment
2. The mental or physical impairment must be “substantially limiting”.
3. The impairment must substantially limit one or more major life activities. If any of the three criteria are missing, do not create a 504 plan for the student.

Even if a student has a disability, he may not need a Section 504 plan. Evaluate not only whether the student has a disability, but also whether he needs related aids, services, or other accommodations to access programs and activities of the District as adequately as his non-disabled peers.

Step 2: Referral

1. If the student meets all three criteria, a referral form is created. It can be initiated by parents, school staff, community agencies, medical providers, the student, or other concerned parties.
2. 504 Referral is submitted to District’s designated Section 504 Coordinator, which is Jessica Hofmeister jessicahofmesiter@haxtunk12.org

Step 3: Determination Regarding Evaluation

1. District’s 504 Coordinator in collaboration with appropriate school staff determines whether or not a 504 evaluation will be conducted.
2. If it is determined that an evaluation will NOT occur, the 504 Coordinator will notify the student’s guardians as to the reasons why and provide them with a copy of the complete referral form and a copy of the Student and Parent Rights under Section 504.
3. If it is determined that an evaluation WILL occur, the 504 Coordinator will work with persons knowledgeable about the student to determine the data to be collected as part of the evaluation.
4. After determining the data to be collected, the 504 Coordinator will complete and send the Section 504 Notice of Evaluation and a copy of the Student and Parent Rights under Section 504 to the students’ guardian.

Step 4: The 504 Evaluation

1. An evaluation by appropriate school personnel must be completed prior to determining a student’s eligibility under Section 504 and prior to any significant change in placement.
2. Evaluations should include information from a variety of sources.

Step 5: Scheduling the 504 Eligibility Meeting

1. Within 60 days of referral, the District's 504 Coordinator invites guardians to attend by sending a Notice of Section 504 Meeting which will include invited individuals knowledgeable about the student.

Step 6: 504 Eligibility Meeting/Creation of Section 504 Plan

1. The 504 team meets to review the evaluation data collected, and determines whether the student is eligible for a Section 504 accommodation plan. Parents/guardians must be given the opportunity to provide input.
2. The team uses the 504 Eligibility Determination Report to document the team’s consideration of the evaluation data and its analysis of the student’s eligibility under Section 504.
3. If the student is found eligible for a 504 plan, the team completes the accommodation section (Part C).
4. Parents/guardians receive a copy of the finalized Section 504 Eligibility Determination Report and, if requested, a copy of the Student /Parent Rights under Section 504..

Step 7: Implementation of 504

1. If the student is found eligible, the team will assign a case manager to oversee the implementation of the student’s Section 504 plan.
2. The case manager provides a copy of the student’s 504 (Part C of the Section 504 Eligibility Determination Report) to administrators, teachers, and other staff responsible for implementation.
3. Case manager monitors the implementation of the plan, communicates the student's progress to parent/guardian, communicates plan to all necessary staff, and attends any review/reevaluation meetings.

Step 8: Section 504 Plan Review

1. The 504 plan is reviewed annually or whenever information is received that indicates a need for review.
2. At the review meeting, the 504 team will review the student’s progress and any relevant information provided by parents/guardians and/or school staff.
3. The team will complete the Section 504 Review Report and update the plan, as appropriate.
4. If the plan is updated, the student’s case manager is responsible for completing and providing a copy of the student’s new accommodation plan to administrators, teachers, and other district staff responsible for implementation.

Step 9: Reevaluation

1. Students shall be reevaluated at least every three years, unless the District and parents/guardians agree that a reevaluation is unnecessary. A reevaluation must occur prior to any significant change of placement.
2. Following the reevaluation, an eligibility meeting is convened in accordance with Step 5.