504 Information
504 information for Parents and staff.
A 504 plan covers accommodations necessary for a student with a disability who has a substantial limitation in the ability to perform a major life activity. The student must have a disability, and not qualify for special education services or the need for specialized instruction.
Here is a chart listing the major life activities:
Substantial Limitation Rating Scale
Place an "X" on the following scale to indicate the specific degree that the impairment(s) (in #3) limits each of the major life activities checked above:
|
Major Life Activity |
Ability to Perform a Major Life Activity Mark “No” if the student is unable to perform this major life activity. No further rating required. |
OR |
Restriction of Condition, Manner, or Duration of Performing a Major Life Activity To what degree is the student restricted as to the condition, manner, or duration under which the major life activity is performed in comparison to the average person in the general population. |
Based on the review: Is there a Substantial Limitation? |
|
Caring for oneself |
❑ No ❑ Yes |
OR |
Mild Moderate Substantial Severe ❑ ❑ ❑ ❑ 1 2 3 4 |
❑ No ❑ Yes |
|
Performing Manual Tasks |
❑ No ❑ Yes |
OR |
Mild Moderate Substantial Severe ❑ ❑ ❑ ❑ 1 2 3 4 |
❑ No ❑ Yes |
|
Seeing |
❑ No ❑ Yes |
OR |
Mild Moderate Substantial Severe ❑ ❑ ❑ ❑ 1 2 3 4 |
❑ No ❑ Yes |
|
Hearing |
❑ No ❑ Yes |
OR |
Mild Moderate Substantial Severe ❑ ❑ ❑ ❑ 1 2 3 4 |
❑ No ❑ Yes |
|
Eating |
❑ No ❑ Yes |
OR |
Mild Moderate Substantial Severe ❑ ❑ ❑ ❑ 1 2 3 4 |
❑ No ❑ Yes |
|
Sleeping |
❑ No ❑ Yes |
OR |
Mild Moderate Substantial Severe ❑ ❑ ❑ ❑ 1 2 3 4 |
❑ No ❑ Yes |
|
Walking |
❑ No ❑ Yes |
OR |
Mild Moderate Substantial Severe ❑ ❑ ❑ ❑ 1 2 3 4 |
❑ No ❑ Yes |
|
Standing |
❑ No ❑ Yes |
OR |
Mild Moderate Substantial Severe ❑ ❑ ❑ ❑ 1 2 3 4 |
❑ No ❑ Yes |
|
Lifting |
❑ No ❑ Yes |
OR |
Mild Moderate Substantial Severe ❑ ❑ ❑ ❑ 1 2 3 4 |
❑ No ❑ Yes |
|
Bending |
❑ No ❑ Yes |
OR |
Mild Moderate Substantial Severe ❑ ❑ ❑ ❑ 1 2 3 4 |
❑ No ❑ Yes |
|
Speaking |
❑ No ❑ Yes |
OR |
Mild Moderate Substantial Severe ❑ ❑ ❑ ❑ 1 2 3 4 |
❑ No ❑ Yes |
|
Breathing |
❑ No ❑ Yes |
OR |
Mild Moderate Substantial Severe ❑ ❑ ❑ ❑ 1 2 3 4 |
❑ No ❑ Yes |
|
Learning |
❑ No ❑ Yes |
OR |
Mild Moderate Substantial Severe ❑ ❑ ❑ ❑ 1 2 3 4 |
❑ No ❑ Yes |
|
Reading |
❑ No ❑ Yes |
OR |
Mild Moderate Substantial Severe ❑ ❑ ❑ ❑ 1 2 3 4 |
❑ No ❑ Yes |
|
Concentrating |
❑ No ❑ Yes |
OR |
Mild Moderate Substantial Severe ❑ ❑ ❑ ❑ 1 2 3 4 |
❑ No ❑ Yes |
|
Thinking |
❑ No ❑ Yes |
OR |
Mild Moderate Substantial Severe ❑ ❑ ❑ ❑ 1 2 3 4 |
❑ No ❑ Yes |
|
Communicating |
❑ No ❑ Yes |
OR |
Mild Moderate Substantial Severe ❑ ❑ ❑ ❑ 1 2 3 4 |
❑ No ❑ Yes |
|
Working |
❑ No ❑ Yes |
OR |
Mild Moderate Substantial Severe ❑ ❑ ❑ ❑ 1 2 3 4 |
❑ No ❑ Yes |
|
Operation of a major bodily function |
❑ No ❑ Yes |
OR |
Mild Moderate Substantial Severe ❑ ❑ ❑ ❑ 1 2 3 4 |
❑ No ❑ Yes |
Here is a website with more information on 504 - Americans with Disabilities Act:
https://www.verywell.com/what-is-a-504-plan-3104706