Fillable BIE Section 504 Consent For Initial Evaluation Form (Bureau of Indian Affairs)

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BIE Section 504 Consent For Initial Evaluation Form (Bureau of Indian Affairs)

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The BIE Section 504 Consent For Initial Evaluation Form (Bureau of Indian Affairs) form is 1 page long and contains:

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Country of origin: US
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U.S.A. forms for Bureau of Indian Affairs

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Student’s Name: DOB: / / Grade: NASIS #:
School:
Parent or Guardian:
Home Address:
Home Phone: Alternate Phone:
CONSENT FOR INITIAL EVALUATION
______ YES, I AGREE to an evaluation of my child under Section 504 of the Rehabilitation Act of 1973 to determine if he
or she has physical or mental impairment which may substantially limit one or more major life activities.
______ NO, I DO NOT agree to an evaluation of my student under Section 504 of the Rehabilitation Act of 1973 to
determine if he or she has physical or mental impairment which may substantially limit one or more major life
activities.
_____________________________________________________ _____/_____/ __________
Parent or Guardian Signature Date
504 PROCEDURAL SAFEGUARDS
______ ____________ Please initial and date to show that you have received a copy of the Section 504 Procedural
Safeguards.
An interpreter was _____ needed _____not needed to explain the Notice.
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BIE Section 504 Consent For Initial Evaluation Form (Bureau of Indian Affairs)

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Completed 26 January 2021

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