Section 504 Identification Determination Summary
The Section 504 Team reviewed and carefully considered the following data that was gathered from the
following sources, including the Referral Document. (Please check all that apply.)
Teacher/Administrator input
Disciplinary records/referrals
Standardized Tests/Other Assessments
School Health Information
Medical Evaluations/diagnoses from
parents
Based on the evaluation data gathered from a variety of sources, the Section 504 Team
answered the following questions to determine Section 504 identification:
1. Does the student have a physical or mental impairment? If so, please describe the
impairment.
2. Does the physical or mental impairment affect one or more major life activities? If so, which
major life activity or activities is/are affected?
3. Does the physical or mental impairment substantially limit a major life activity?
4. Does the student need Section 504 accommodations?
If all four questions were answered “Yes,” the student is identified for accommodations under Section 504, and
the Section 504 Accommodation Plan should be developed. If any answer is “No,” the student is not identified.
The Section 504 Team’s analysis of the identification criteria as applied to the evaluation data indicates
that:
The student is not identified for services under Section 504 and will continue to receive general
education and any available regular education resources and programs.
The student is identified under Section 504 and will receive an Individualized Accommodation Plan,
which governs the provision of 504 services to the student.
The student remains identified under Section 504 and will receive an updated Individualized
Accommodation Plan, which governs the provision of 504 services to the student. (Annual and 3-
year evaluations only)
The student is no longer identified for Section 504 and is exited from the program. The student will
now receive general education without Section 504 services.
