"Section 504 Parental Consent for Evaluation" - Georgia (United States)

Section 504 Parental Consent for Evaluation is a legal document that was released by the Georgia Department of Education - a government authority operating within Georgia (United States).

Form Details:

  • Released on August 1, 2018;
  • The latest edition currently provided by the Georgia Department of Education;
  • Ready to use and print;
  • Easy to customize;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a fillable version of the form by clicking the link below or browse more documents and templates provided by the Georgia Department of Education.

ADVERTISEMENT
ADVERTISEMENT

Download "Section 504 Parental Consent for Evaluation" - Georgia (United States)

Download PDF

Fill PDF online

Rate (4.4 / 5) 14 votes
Page background image
Type Name of School District
Section 504 Parental Consent for Evaluation
__________________________
(Date)
Dear Parent of ____________________________________.
(Child’s Name)
Your child was referred by ________________________________ and was recommended for
evaluation by the Student Support Team. The referral indicates that your child may be eligible for
supports and/or services under Section 504 of the 1973 Rehabilitation Act. We would like to
begin the process of determining whether your child qualifies for Section 504 protections.
The next step in determining eligibility is an evaluation that may include (but is not limited to) a
review and/or administration of the following:
▪ Grades
▪ Discipline Records
▪ Behavioral
▪ Parent Reports
▪ Medical Tests
Assessment
▪ Teacher Reports
▪ Achievement Tests
▪ Psychological
▪ Academic Records
▪ Work Samples
Evaluation
Upon completion of an evaluation, you will be invited to a meeting to discuss the evaluation
results and possible eligibility for Section 504 supports and accommodations. No changes will be
made in your child’s educational program until we hold the meeting and you provide any
additional consent. Providing this consent to evaluate does not allow the system to provide
Section 504 supports or accommodations.
Please indicate your decision to have your child evaluated for Section 504 services below.
❑ Yes, I agree for my child ______________________________________ to be evaluated.
❑ No, I do not agree for the following reasons:
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
Georgia Department of Education
Model Form | August 2018
Type Name of School District
Section 504 Parental Consent for Evaluation
__________________________
(Date)
Dear Parent of ____________________________________.
(Child’s Name)
Your child was referred by ________________________________ and was recommended for
evaluation by the Student Support Team. The referral indicates that your child may be eligible for
supports and/or services under Section 504 of the 1973 Rehabilitation Act. We would like to
begin the process of determining whether your child qualifies for Section 504 protections.
The next step in determining eligibility is an evaluation that may include (but is not limited to) a
review and/or administration of the following:
▪ Grades
▪ Discipline Records
▪ Behavioral
▪ Parent Reports
▪ Medical Tests
Assessment
▪ Teacher Reports
▪ Achievement Tests
▪ Psychological
▪ Academic Records
▪ Work Samples
Evaluation
Upon completion of an evaluation, you will be invited to a meeting to discuss the evaluation
results and possible eligibility for Section 504 supports and accommodations. No changes will be
made in your child’s educational program until we hold the meeting and you provide any
additional consent. Providing this consent to evaluate does not allow the system to provide
Section 504 supports or accommodations.
Please indicate your decision to have your child evaluated for Section 504 services below.
❑ Yes, I agree for my child ______________________________________ to be evaluated.
❑ No, I do not agree for the following reasons:
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
Georgia Department of Education
Model Form | August 2018
Type Name of School District
Here
Section 504 Parental Consent for Evaluation
This form should be signed below and then returned to:
Name
Title
Phone Number
If we do not receive this form by ___________________, we will contact you about your
decision.
(Date)
Signature of Parent
Date
Georgia Department of Education
Model Form | August 2018
Page of 2