Student Name: Mayer, Daisy Maedean 504 Student Accommodation Student ID: 68287348

School: Legacy Traditional School - N

Chandler Plan DOB: 3/1/2010

Student Name: Mayer, Daisy Maedean Student ID: 68287348

School: Legacy Traditional School - N Chandler Date of Birth: 3/1/2010 Grade: 4
Date: 10/18/2019

Date 504 Plan Initiated: 10/18/2019 Date 504 Plan should be reviewed: 10/16/2020

Qualifying Disability: ADHD

Classroom Accommodations:

Area(s) of Need Accommodation(s) Person Responsible

Concentration/Focus Extended time on assignments and All teachers

assessments
Concentration/Focus During independent work time or test, All teachers
Daisy can be pulled as needed to work
one on one

Concentration/Focus Preferential seating near responsible All teachers

and quiet students
Organization/Focus Provide a step by step checklist in a All teachers
variety of areas (i.e.
unpacking/packing, math)

Concentration/Focus Break down assignments by providing All teachers

fewer problems upfront. Once
completed provide the next couple of
problems

Concentration/Focus As needed, Daisy can have a All teachers, Daisy

movement break (i.e. walk to the
bathroom, walk to get a drink,
errands, pacing the back of the room)
Concentration/Focus Provide extra incentives beyond the All teachers
class incentives (i.e. earning extra
stickers on her sticker chart)

Describe location of services and the reason(s) necessary, or any other relevant information:
In general education classroom and special areas

Participation of Eligible 504 Student in the State Assessment/Civics Standardized Testing:

State Assessment Testing:

The student should take the State Assessment under routine conditions, without any accommodations.
504 Site Designee name: Student name: Campus: Grade:

504 Annual Review

Important Dates

Meeting Notice sent

Meeting

504 Start

504 End

504 Eligibility Start

504 Eligibility End

Required Paperwork

504 Parent Invitation

504 Student Accommodation Plan

Checklist
504 dates are in compliance and the 504 is on time.

Parent Rights given to parents.

Current 504 documents are marked “most recent” and “locked” in IEPPRO.

504 student box checked on profile, case manager assigned & student showing on reports.

Copies of 504 accommodation plan were distributed to ALL relevant parties (school staff, admin, and parents)

Spreadsheets have been updated to reflect current dates

Signature pages uploaded to Supporting Documents in eIEPpro

ESS Compliance Verification (Vertex use only):

❒ Checklist ❒ PowerSchool ❒ square9 ❒ e-IEPPRO ❒ Master List
504 Site Designee name: Student name: Campus: Grade:

NCH

504 Eligibility & Accommodation Plans

Important Dates

Meeting Notice sent

504 Start (Meeting date)

504 End (Review date)

504 Eligibility Start

504 Eligibility End

Required Paperwork
504 Evaluation Referrals ​ [ ] Parent/guardian copy [ ] Teacher Copy

504 Notice of Evaluation

504 Parent Consent (with parent/guardian signatures)

504 Parent Invitation ​[ ] Eligibility Determination [ ] 504 Accommodation Plan

504 Review of Existing Data (with signatures)

504 Eligibility Determination Report (with signatures)

504 Eligibility or Non-Eligibility Determination

504 Student Accommodation Plan ​(Initiation date -date of the current 504 meeting, review date a year from meeting date.

Misc. Documents: Medical information, diagnoses, outside evaluation data/information,etc.

ESS Compliance Verification (Vertex use only):

❒ Checklist ❒ PowerSchool ❒ Square9 ❒ e-IEPPRO ❒ Master List ​ Updated
2/7/19
504 Site Designee name: Student name: Campus: Grade:

NCH

Checklist
504 dates are in compliance and the 504 is on time. Review date would be annually. Re-evaluation date would
be at least every three years.

Parent Rights have been given to parents/guardian.

Current 504 documents are marked​ “most recent”​ and ​“locked”​ in e-IEPPRO.

Designee name has been added within e-IEPPRO in the student profile section as ​Case Manager​ and ​504
Coordinator​ and ​Site Leader

504 student box checked within student profile section within e-IEPPRO - This step is crucial to run 504 reports,
etc.

Copies of documents were given to parents/guardians. 504 accommodation plan was distributed to ALL relevant
parties (school staff, administration,etc.)

Campus Datadashbord has been updated and reflect current dates

Paperwork has been sent to district in a timely manner (3-7 days after the 504 accommodation plan meeting was
held)

ESS Compliance Verification (Vertex use only):

❒ Checklist ❒ PowerSchool ❒ Square9 ❒ e-IEPPRO ❒ Master List ​ Updated
2/7/19