Section 504 Plan
CON F I DE NTIAL
MCPS Form 270-2
January 2017
Page 1 of 4
Office of Student and Family Support and Engagement
MONTGOMERY COUNTY PUBLIC SCHOOLS (MCPS)
Rockville, Maryland 20852
INSTRUCTIONS: Please see last page for all instructions.
PART I. INSTRUCTIONAL ACCOMMODATIONS
Today’s Date ____/____/_____ Check one: o Initial Plan o Updated Plan
Student Name________________________________________________________ Student ID#___________ Date of Birth ____/____/_____
Choose One -School__-____________________________________________________________________________________________________
Grade____
NAMES AND TITLES OF PARTICIPATING MEMBERS: (Note: A Section 504 school-based team must be composed of a group of
persons, including persons knowledgeable about the student, the meaning of evaluation data, and placement/accommodations options.)
1.
5.
2.
6.
3.
7.
4.
8.
1. BACKGROUND INFORMATION
Date when the Section 504 school-based team found the student eligible under Section 504____/____/_____ .
What is the physical or mental impairment?_______________________________________________________________________________
What major life activity is substantially limited by the impairment? (list all applicable)___________________________________________
_____________________________________________________________________________________________________________________
_____________________________________________________________________________________________________________________
Reason(s) student requires accommodations_______________________________________________________________________________
2. SECTION 504 PLAN
ACCOMMODATIONS
LOCATION
(e.g., specific class, all classes, cafeteria)
STAFF MEMBER(S)
RESPONSIBLE
Date plan will be reviewed ____/____/_____ Case Manager Name and Title__________________________________________________
NOTE: T
he Section 504 Plan information must be entered in Online Administrative Student Information System (OASIS). This
Plan will expire in OASIS one year from the start date of the Section 504 Plan.
DISTRIBUTION: Copy 1/Student’s confidential file; Copy 2/Parent/Guardian/Eligible Student; Copy 3/Case Manager;
Copy 4/Student’s Teacher(s); Copy 5/ School Community Health Nurse/School Health Room Technician (if applicable)
MCPS Form 270-2
Page 2 of 4
PART II. MARYLAND TESTING ACCOMMODATIONS FOR STUDENTS WITH A SECTION 504 PLAN (Check all that apply)
1. PRESENTATION ACCOMMODATIONS
o 1-A Large Print
o 1-J* Audio Materials
o 1-B Magnification devices
o 1-K Descriptive/Captioned Video
o1-C Interpretation/Translations for the Deaf or Hard of Hearing
o1-L Text-to-Speech Software for verbatim reading of entire test
o1-D Braille
o 1-M Text-to-Speech Software for selected sections of test
o 1-E Tactile graphics
o 1-N Screen Reading Software
o 1-FHuman Reader or Audio Recording for verbatim reading
of entire test
o 1-OVisual cues
o 1-GHuman Reader or Audio Recording for verbatim reading
of selected sections of test
Unique presentation accommodations determined on
o1-Q
a case-by-case basis in consultation with the Maryland
State Department of Education (MSDE)
Explain
o 1-HAudio amplication devices
o None required (no code)
o 1-PNotes and Outlines
*1-I omitted
2. RESPONSE ACCOMMODATIONS
o2-A Scribe
o 2-J* Mathematics Tools and Calculation Devices
o 2-BAugmentative communication and speech-generating
devices
o 2-K Spelling and grammar devices
o 2-C Braille writer system
o 2-M Graphic organizers
o 2-D Electronic word processors
o 2-N Computer Access Tools/Devices/Software
o 2-E Electronic Braille notetakers
o 2-O Writing Tools/Implements
o 2-FRecording devices
o2-P
Unique presentation accommodations determined on
a case-by-case basis in consultation with the Maryland
State Department of Education (MSDE)
Explain
o 2-GRespond on test booklet
o 2-HMonitor test response
o None required (no code)
o2-L Visual organizers
*2-I omitted
3. TIMING AND SCHEDULING ACCOMMODATIONS
o 3-A Extended time (specify)______________________________
o 3-D Change schedule or order of activities—Within one day
o 3-B Multiple or frequent breaks
o3-E Unique timing and scheduling accommodations determined
on a case-by-case basis in consultation with MSDE
Explain
o 3-CChange schedule or order of activities—Extend over
multiple days
o None required (no code)
4. SETTING ACCOMMODATIONS
o 4-A Reduce distractions to the student
o 4-B Reduce distractions to other students
o 4-CChange location to increase physical access or to use
special equipment—Within school building
o None required (no code)
o 4-DChange location to increase physical access or to use
special equipment—Outside school building
o 4-EUnique setting accommodations determined on a caseby-case basis in consultation with MSDE
Explain
MCPS Form 270-2
Page 3 of 4
PART III. PARCC TESTING ACCOMMODATIONS FOR STUDENTS WITH A SECTION 504 PLAN ((Select the appropriate
accommodations in accordance with PARCC requirements) See Page 4 for PARCC Testing Accessibility Features, Administrative
Considerations, and Accommodations for ALL students.
1. PARCC ACCESSIBILITY FEATURES
If needed, can select one of the following:
o Text-to-Speech (text only) for the Mathematics Assessment
oText-to-Speech (text and graphics) for the Mathematics
Assessment
o Human Signer for the Mathematics Assessments
o Human Reader for the Mathematics Assessments
o Answer Masking
o Color Contrast (Background/Font Color)
o Student Reads Assessment Aloud to Self
2. PARCC ADMINISTRATIVE CONSIDERATIONS
o Small Group Testing
o Time of Day
o Separate or Alternate Location
o Specified Area or Setting
o Adaptive and Specialized Equipment or Furniture
o Frequent Breaks
3. PRESENTATION ACCOMMODATIONS
o Assistive Technology (Non-Screen Reader)
oScreen Reader Version
(for a student who is blind or visually impaired)
oRefreshable Braille Display with Screen Reader Version for ELA/
Literacy
oHard Copy Braille Edition
oTactile Graphics
oLarge Print Edition
oPaper-Based Edition (Alternate Representation—Paper Test)
oClosed-Captioning of Multimedia on the ELA/Literacy
Assessments
oText-to-Speech (Text and Graphics) for the ELA/Literacy
Assessments, including items, response options, and passages
(must have MD 1-L)
oAmerican Sign Language (ASL) Video for the ELA/Literacy
Assessments, including items, response options, and passages
(must have MD 1-C)
oHuman Signer for the ELA/Literacy Assessments
(must have MD 1-C)
oHuman Reader for the ELA/Literacy Assessments
(must have MD 1-F)
oAmerican Sign Languages (ASL) Video for the Mathematics
Assessments (must have MD 1-C)
oHuman Signer for Test Directions
oNone required (no code)
4. RESPONSE ACCOMMODATIONS
oAssistive Technology (Non-Screen Reader) ex: adaptive
keyboards
oBraille Notetaker
oBraille Writer
oCalculation Device (on Non-calculator Sections of
Mathematics Assessments) (Option C–Calculator only)
oMathematics Tools (on Non-calculator Sections of
Mathematics Assessments) (Option T–Math Tools only)
oCalculation Device and Mathematics Tools (on Non-Calculator
Sections of Mathematics Assessments) (Option B–Both
Calculator and Math Tools)
ELA/Literacy Selected Response Options: (select only one, if needed)
o Speech-to-Text (must have MD 2-B)
o Human Scribe (must have MD 2-A)
o Human Signer
o Assistive Technology Device
Mathematics Response Options: (select only one, if needed)
o Speech-to-Text (must have MD 2-B)
o Human Scribe (must have MD 2-A)
o Human Signer
o Assistive Technology Device
ELA/Literacy Constructed Response Options: (select only one, if needed)
o Speech-to-Text (must have MD 2-B)
o Human Scribe (must have MD 2-A)
o Human Signer
o External Assistive Technology Device
o
Monitor Test Response
o
Word Prediction External Device on the ELA/Literacy
Assessment
o
Answers Recorded in Test Book
o
None required (no code)
5. TIMING AND SCHEDULING ACCOMMODATIONS
oExtended Time (specify)
o
None required (no code)
If the student requires a unique accommodation, use Appendix F: Unique Accommodation Request Form in the PARCC
Accommodations Manual located at http://www.parcconline.org/assessments/accessibility/manual.
MCPS Form 270-2
Page 4 of 4
PART IV. DUE PROCESS SAFEGUARDS INFORMATION
The following is a summary of the rights granted by federal law to students with disabilities who qualify under Section 504. If your child qualifies under Section 504,
you have the right to:
1. Have your child take part in, and receive benefits from, public education programs without being discriminated against on the basis of her/his disability;
2. Receive notice with respect to identification, evaluation, reevaluation, or placement/program decisions involving your child;
3. Have your child receive a free appropriate public education. This includes the right to be educated with students who do not have disabilities to the
maximum extent appropriate;
4. Have your child afforded an opportunity, equal to that of students who do not have a disability, to participate in school programs and extracurricular activities
sponsored by the school;
5. Have identification, evaluation, and placement/program decisions made based upon information from a variety of sources, and by persons who know the
needs of the student, the meaning of evaluation data, and placement/program options;
6. Examine your child’s educational records and obtain a copy of those records pursuant to law and Montgomery County Public Schools (MCPS) Regulation
JOA-RA, Student Records;
7. Seek resolution of issues if you are dissatisfied with any decision regarding the identification, evaluation, or placement/program of your child. You may request
a Section 504 review by contacting the compliance officer in the MCPS Resolution and Compliance Unit; or you may request a Section 504 hearing by an
impartial hearing officer by contacting the compliance officer. The hearing provides an opportunity for participation by the parents/guardians and/or student
and representation by counsel. Either party may appeal the decision of the hearing officer and request a review of that decision. In addition, you may contact
the Office for Civil Rights in the U.S. Department of Education.
The person who is responsible for ensuring MCPS’ compliance with Section 504 is the MCPS Section 504 Coordinator, Resolution and Compliance Unit, Carver
Educational Services Center (CESC), Room 208, 850 Hungerford Drive, Rockville, Maryland 20850. Telephone: 301-517-5864; TDD/TTY 301-279-3323.
PARENT/GUARDIAN ACKNOWLEDGMENT
By signing below, I am confirming that I have participated in the development of the Section 504 Plan and have received a copy of the Section 504
Plan and my procedural safeguards under Section 504 of the Rehabilitation Act of 1973.
Parent/Guardian/Eligible Student Signature_________________________________________________________________________Date ____/____/_____
INSTRUCTIONS
PART I
The Section 504 Plan is to be completed by the Section 504 Educational Management Team (EMT) for qualified students who meet the eligibility
requirements as specified in MCPS Regulation ACG-RB, Reasonable Accommodations and Modifications for Students Eligible Under Section 504 of the
Rehabilitation Act of 1973. This Section 504 Plan form must be used in conjunction with MCPS Form 270-2B, Section 504 Evaluation, and MCPS Form
270-2D, Distribution of Section 504 Plan, for initial Section 504 and subsequent Section 504 Plans. Record meeting notes on MCPS Form 272-4,
Educational Management Team Summary. Part I applies to accommodations that do not relate to testing accommodations. Please make sure that for
students with medical conditions you are considering any existing health care plans. If there are additional accommodations which cannot be listed on
the lines provided, please reflect them on MCPS Form 272-4 and write “See Addendum” under the “Accommodations” section and attach MCPS Form
272-4 to the student’s Section 504 Plan. The Section 504 Plan must be reviewed each year prior to or on “the date plan will be reviewed.”
PART II
Test accommodations should be recommended for a student with a disability if the disability substantially limits the student’s ability to complete the
required assessments. The identified accommodations must align with the student’s specific areas of need and educational impact documented at
the most recent Section 504 EMT meeting and reflect ongoing instructional accommodations. The testing accommodations must be provided, in
accordance with the applicable testing guidelines, for the student during informal class tests, assessments, and systemwide Measures of Academic
Progress–Mathematics, Measures of Academic Progress–Reading, and state testing. Please check the appropriate boxes. For additional assistance in
determining the appropriate testing accommodations (non-PARCC) refer to the Maryland Accommodations Manual at the following website: http://
test.msde.maryland.gov/programs/Documents/Testing/2012_MD_Accommodations_Manual.pdf
PART III
Test accommodations should be recommended for a student with a disability if the disability substantially limits the student’s ability to complete
the required assessments. The identified accommodations must align with the student’s specific areas of need and educational impact documented
at the most recent Section 504 EMT meeting and reflect ongoing instructional accommodations. The testing accommodations must be provided
for the student during PARCC assessments. Please check the appropriate boxes. If the student requires a unique accommodation, use Appendix F:
Unique Accommodation Request Form in the PARCC Accessibility Features and Accommodations Manual by the required timeline to the Office of
Shared Accountability (OSA). If a student refuses a particular accommodation, use the Appendix H: Student Accommodation Refusal Form from the
PARCC Accommodations Manual by the required timeline to OSA. Explain to the parent/guardian that these accommodations will only apply to
PARCC assessments. For additional assistance in determining the appropriate testing accommodations refer to the PARCC Accessibility Features and
Accommodations Manual and Frequently Asked Questions at the following website: http://www.parcconline.org/assessments/accessibility/manual.
http://avocet.pearson.com/PARCC/Home#10616
PART IV
The parent/guardian must sign that they have received a copy of the Section 504 Plan. Under Section 504, parent/guardian consent is only required
for evaluations (psychological, education, occupational therapy, physical therapy, speech and language, functional behavioral assessment). Once
the Section 504 EMT has determined the appropriate accommodations, the Section 504 Plan must be implemented by the person(s) responsible. If
the parent/guardian is in disagreement with the Section 504 Plan, they should be advised of their procedural safeguards and referred to the MCPS
Section 504 Coordinator, if additional assistance is required.