Section 504 Coordinator
25 Quality Street
Munfordville, KY 42765
PHONE: 270-524-9345
FAX: 270-524-2634
kristin.froedge@hart.kyschools.us
Section 504 Forms
A Guide to Section 504 Forms...
FORM LIST for Referral Meeting:
--- Notice of Meeting (send home at least 7 calendar days prior to the meeting date)
--- Documentation of Contact (in conjunction with "Notice of Meeting" - listed above)
--- Parent Rights (send copy home & have copy at meeting)
--- Meeting Summary (complete at the meeting)
--- Student Referral (complete as much as possible prior to the meeting; finish at the meeting)
--- Eligibility Evaluation (this is the consent for the evaluation)
--- Health Care Provider Questionnaire (sent by parent to physician after meeting - parent to return to personnel ASAP)
--- Release of Information - HIPPA (Medical Release) - (found on the website; complete at the meeting and obtain parent signature ONLY if a parent wants the school to obtain a completed Health Care Provider Questionnaire - see document above)
FORM LIST for Evaluation Results/Eligibility Review Meeting:
(to be used for review of results at BOTH an initial evaluation AND a three-year reevaluation meeting)
--- Notice of Meeting (send home at least 7 calendar days prior to the meeting date)
--- Documentation of Contact (in conjunction with "Notice of Meeting" - listed above)
--- Parent Rights (have a copy at the meeting)
--- Meeting Summary (complete at the meeting)
--- Evaluation Summary (person completing this shall provide a copy)
--- Eligibility Determination (complete at the meeting as a committee)
--- Notice of Eligibility Determination (complete and send home to guardian ONLY if guardian did not attend the meeting)
--- Accommodation Plan (in case student qualifies; to be completed at meeting; may bring rough draft)
--- Consent for Implementation (if qualified for placement)
FORM LIST for Annual Review Meeting:
(Annual Review Meetings for reviewing & developing Accommodation Plan minimum yearly basis to the last
date for students already identified & placed in the Section 504 Program)
--- Notice of Meeting (send home at least 7 calendar days prior to the meeting date)
--- Documentation of Contact (in conjunction with "Notice of Meeting" - listed above)
--- Parent Rights (have a copy at the meeting)
--- Meeting Summary (complete at the meeting)
--- Accommodation Plan (to be completed at the meeting; may bring rough draft)
--- Consent for Implementation (for the continuation of the Accommodation Plan)
FORM LIST for Three-Year Reevaluation Meeting:
(Three-Year Reevaluation Meetings for reviewing (always), retesting (if applicable), & redetermining eligibility (always) occur at a minimum of every 3 years to the last date for students already identified & placed in the Section 504 Program)
--- Notice of Meeting (send home at least 7 calendar days prior to the meeting date)
--- Documentation of Contact (in conjunction with "Notice of Meeting" - listed above)
--- Parent Rights (have a copy at the meeting)
--- Meeting Summary (complete at the meeting)
--- Eligibility Evaluation (this is the consent for the evaluation)
--- Eligibility Determination (complete at the meeting as a committee)
--- Health Care Provider Questionnaire (sent by parent to physician after meeting - parent to return to personnel ASAP)
--- Release of Information - HIPPA (Medical Release) - (found on the website; complete at the meeting and obtain parent signature ONLY if a parent wants the school to obtain a completed Health Care Provider Questionnaire - see document above
FORM LIST for Disciplinary Meeting:
--- Notice of Meeting (send home at least 7 calendar days prior to the meeting date)
--- Documentation of Contact (in conjunction with "Notice of Meeting" - listed above)
--- Parent Rights (have a copy at the meeting)
--- Meeting Summary (complete at the meeting)
--- Impartial Hearing (have a copy at the meeting for parent and committee if needed)
--- Manifestation Determination (complete at the meeting)
--- Accommodation Plan (bring a current plan and new blank form so that the old can be reviewed AND a new one can be written if needed to help address behavioral issues - blank form will not necessarily be utilized)
--- Consent for Implementation (for the continuation of Accommodation Plan)
--- RECOMMENDATION: It is recommended that you locate two additional pieces of paperwork found in Infinite Campus (Functional Behavioral Assessment [FBA] & Behavioral Intervention Plan [BIP]) - personnel from the special education department can assist with locating these as both should be completed for any student with behavioral concerns.