Fillable CONSENT TO REVIEW EVALUATIVE INFORMATION SECTION 504 (Bureau of Indian Affairs)

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CONSENT TO REVIEW EVALUATIVE INFORMATION SECTION 504 (Bureau of Indian Affairs)

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File type: PDF

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CONSENT TO REVIEW EVALUATIVE INFORMATION
SECTION 504
Student Name: ______________________________________________
School: ______________________________________________
Student Id/NASIS#: __________________ Date: ____________________
DATA/INFORMATION TO BE REVIEWED When evaluating the case, the Section 504 team will review
a variety of available information to make informed decisions about the student. Please check the
available information to be reviewed.
___Teacher reports
___Educational records
___Medical reports
___Report cards Student
attendance
___Observations
___Student health records
___Aptitude or achievement
tests
___Information from
parents
___Developmental reports
___Documentation of
Interventions
___Residential program
records
___Psychological reports
___Attendance records
___Extracurricular
activities
___School Incident Reports
___ Individualized Education Program team decisions (if applicable)
Other (explain):
Other (explain):
Other (explain):
I authorize the school to evaluate the above data/ information for my child to determine possible
identification for Section 504 accommodations/services.
____________________________ ____________________________ ___________________
Parent/Guardian Name (Printed) Signature of Parent/Guardian Date
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CONSENT TO REVIEW EVALUATIVE INFORMATION SECTION 504 (Bureau of Indian Affairs)

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Completed 26 January 2021

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