Section 504 Plan - Joe Smith 2020(1)


Immanuel Lutheran School
200 N. Plum Grove Rd.  Palatine, IL  60067
(847) 359-1936

SECTION 504 PLAN


Student Name: Joe Smith
Birth Date: 
Grade: 
Teacher:  

Initial Eligibility Date: 
504 Conference Date: 
Anticipated Re-Evaluation Date: 

Paricpants' Names/Titles: 
Father: 
Mother: 
Resource Teacher: 
Teacher: 
Principal: 

Disabling Condition:
The following accommodations and/or health plan have been agreed upon by school staff, parent(s), and student as being necessary for the stdent to have an educational opportunity equal to the aerage student in the general population.


The following accomodation(s) are the responsibility of the Classroom teachers and School Team

Accomodation 1
  Date Accomodation Started:
  Substantial Limitation as evidenced by:
  Accademic/School Accomodation

Accomodation 2
  Date Accomodation Started:
  Substantial Limitation as evidenced by:
  Accademic/School Accomodation

Accomodation 3
  Date Accomodation Started:
  Substantial Limitation as evidenced by:
  Accademic/School Accomodation

Accomodation 4
  Date Accomodation Started:
  Substantial Limitation as evidenced by:
  Accademic/School Accomodation

The following accomodation(s) are the responsibility of the Classroom teachers, School Team and Media Teacher

Accomodation 1
  Date Accomodation Started:
  Substantial Limitation as evidenced by:
  Accademic/School Accomodation

Accomodation 2
  Date Accomodation Started:
  Substantial Limitation as evidenced by:
  Accademic/School Accomodation


Additional supports or services: 

Conference Notes: 

Anticipated Annual Review Date: 


Signatures 

Student Name: 
Birth Date: 
Date of Meeting:  


Conference Participants:

Conference Participants Name/Title: 

Father:  

Mother:  

Resource Teacher:  

Principal:  

Teacher:  

Anticipated Annual Review Date: 

 I have received a link to ISBE 504 regulations and procedures:
                https://www.isbe.net/Pages/Special-Education-Civil-Rights.aspx

Leave this empty:

Signature arrow sign here


Signature Certificate
Document name: Section 504 Plan - Joe Smith 2020(1)
lock iconUnique Document ID: 641725ecdd8b0b9ac33724c6f416739b9aa39592
Timestamp Audit
October 25, 2021 7:07 pm CDTSection 504 Plan - Joe Smith 2020(1) Uploaded by ILCP - Immanuel Lutheran Church & School - immanuel@ilcp.org IP 99.116.27.149
Audit trial Qr code
This audit trail report provides a detailed record of the online activity and events recorded for this document.
https://www.immanuelpalatine.org/
Audit Trail Serial# 865f8a5cc4bdd02d9562bbca45744c06