[Date]
[Section 504 coordinator's name]
[School name]
[School address]
Re: Request for a Section 504 evaluation and plan for [Student name], date of birth [Date of birth], grade 7
To the Section 504 team:
I am the treating child and adolescent psychiatrist for [Student name], a student in grade 7 at [School name], whom I have treated since [month and year treatment began]. I am writing at the request of the student's parent or guardian to support their request that the school evaluate the student for a Section 504 plan. The parent or guardian has signed a release permitting me to share this information with the school and to speak with the team.
Diagnosis and treatment
[Student name] has been diagnosed with attention-deficit/hyperactivity disorder and an anxiety disorder, on the basis of clinical evaluation and standardized rating scales completed by the family and, where available, by school staff. Current treatment consists of medication management and psychotherapy.
Treatment does not remove the need for accommodation. Under the ADA Amendments Act, whether an impairment substantially limits a major life activity is determined without regard to the ameliorative effects of mitigating measures such as medication. The student's functioning on medication, which is what the school sees, is not the measure of the underlying impairment, and medication effects vary across the school day.
How the condition affects the student at school
In the school setting, the student cannot sustain attention through classroom instruction and misses directions, particularly multi-step directions given aloud; understands the material but frequently does not complete or hand in work, so grades reflect output rather than knowledge; loses materials, misses deadlines, and cannot independently plan and sequence long assignments; and performs on tests well below the level of knowledge demonstrated in class and in conversation. [Add one or two specific observations reported by the family or school, with approximate dates.]
These difficulties substantially limit the major life activities of learning, concentrating, and thinking, as those terms are used in Section 504 and the Americans with Disabilities Act, and they limit the operation of neurological and brain functions, which the statute lists among the major bodily functions. The student's condition is a mental impairment within the meaning of Section 504, and the student is, in my clinical judgment, a student with a disability who needs accommodations to have access to the general curriculum equal to that of peers.
Recommended accommodations
I recommend that the plan include the following accommodations. Each is a standard accommodation for this presentation, and the wording below is the form in which each is usually written into a plan.
- Extended time on tests and assignments. Student will receive 50% additional time on all classroom and standardized assessments.
- Testing in a separate, low-distraction setting. Student will complete assessments in a separate setting with minimal distractions.
- Preferential seating. Student will be seated near the point of instruction and away from high-traffic areas.
- Written instructions and a copy of class notes. Teachers will provide written directions for multi-step assignments and access to class notes or slides.
- Organizational support. Long-term assignments will be broken into steps with interim due dates, and the student's planner will be reviewed weekly by a designated staff member.
Request
- Convene the Section 504 team to evaluate the student for eligibility, drawing on this letter, the family's report, and the school's own observations, as the regulations require of an evaluation that draws on a variety of sources.
- If the student is found eligible, develop a written plan that includes the accommodations above, with a review date.
- Provide the parent or guardian with written notice of the team's decision and of the procedural safeguards that apply.
- Invite me to the team meeting or arrange a call beforehand. I can be reached at the number below, and with the release on file I am able to answer the team's questions directly.
This letter sets out my clinical findings and recommendations. Decisions about eligibility and services belong to the school team, and my aim is to make sure the team has what it needs to reach them.
Sincerely,
[Your name]
[Credentials and role]
[Practice or hospital]
[Direct phone and fax]
Enclosures: [Signed release of information.]