Sample Letter to Request an Evaluation for 504 Plan Eligibility

The purpose of a 504 plan is to give a student equal access at school and school activities.

For an individual to be eligible under Section 504, they must:

1. Have a disability that substantially limits one or more major life activities; AND
2. Need accommodations to prevent discrimination based on disability.

For definitions of the language above please see the ASK document titled “504 Plan for Students with Disabilities: Section 504 of the Rehabilitation Act.”

Each district determines their own policies and procedures around evaluation and eligibility under Section 504. Each district will have at least one coordinator that oversees Section 504. Parents can request a copy of the District 504 Policy Manual and Procedures Guide which describes how the district meets these obligations. The determination of whether a student has a physical or mental impairment that substantially limits a major life activity is determined by the 504 team on an individual basis.

A parent may request a 504 plan through the school's 504 coordinator or principal. It is strongly recommended that the request be in writing. Below is a sample letter a parent may use to make this request.

Sample Letter

Date
Dear ___________:
I am the parent of (student’s full name), who is a (number) grade student in the (district name) School District and attends (name of building). I am concerned that my child may need accommodations to support them in school due to their disability To address these concerns, I am requesting that (student’s name) be considered for a 504 plan pursuant to Section 504 of the Rehabilitation Act. I believe my child is a protected student because (list reasons why the child has a mental or physical impairment that substantially limits a major life activity, such as learning, thinking, concentrating, breathing, walking, etc. and provide a specific diagnosis, such as asthma, diabetes, ADHD, Tourette Syndrome, etc.).

Thank you in advance for your collaborative efforts to provide (student’s name) with the accommodations (he/she/they) needs to allow equal access at school and school activities.

I look forward to hearing from you in a timely manner. I can be reached during daytime hours at (phone number) or at the email address listed below. Thank you for your attention to this request.

Sincerely,
(Your name, address and email)