Fillable BUREAU OF INDIAN EDUCATION .i Doing What's (Bureau of Indian Affairs)

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BUREAU OF INDIAN EDUCATION .i Doing What's (Bureau of Indian Affairs)

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  • 36 check-boxes
  • 31 other fields

Country of origin: US
File type: PDF

U.S.A. forms for Bureau of Indian Affairs

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BUREAU
OF
INDIAN
EDUCATION
· · Doing What's
Best
for
Student.s!
504 Eligibility Determination
Student ID:
Meeting Date:
Name:
Parent/Guardian 1:
Birthdate:
Parent/Guardian 2:
School:
Grade:
School Contact Person:
Position:
Eligibility Team Members (For each member, check whether s/he is knowledgeable about the child, the meaning of the
evaluation data, and/or accommodations/placement options.)
TEAM MEMBER:
Child
Meaning of
Evaluation
Data
Accommodations& Placement
Options
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Sources of Evaluation Information (check each one used)
achievement tests
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medical/psychological report
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other . . .
adaptive behavior
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student work samples
cognitive assessments
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teacher recommendations/observations
1. Specify the mental or physical impairment:
2. Check the major life activity(ies) affected by the impairment:
seeing
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hearing
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caring for oneself
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breathing
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concentrating
walking
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learning
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manual tasks
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working
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other:
3. Please refer to NPM-EDUC-33 for an explanation of the “substantially limits” standard.
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.i
BUREAU
OF
INDIAN
EDUCATION
· · Doing What's
Best
for
Student.s!
I have participated in determining
eligibility for the above named
student under Section 504.
Participant's Name
Title
Participant's Signature
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Parent provided a copy of the Section 504 Parental Rights-Parent Signature: __________________________
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signature
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BUREAU OF INDIAN EDUCATION .i Doing What's (Bureau of Indian Affairs)

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Completed 26 January 2021

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