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