504 Referral

Click in the Meeting Date box.  A calendar will pop up.  Select the date the referral meeting was held..

Input the name of the person who submitted the referral.

Input the individuals role.

Click within the boxes to select the concerns that prompted the referral.  If you click “other”, a text box will appear for you to indicate other concerns.

Click within the box that indicates if the student has been evaluated or has received IDEA services. If the student previously received services then additional choices will open. Click on the boxes indicating what supports the student received while in IDEA services. If you click “other”, a text box will appear for you to indicate other supports.

Click within the boxes to select the major life activities that are impaired.  If you click “other”, a text box will appear for you to indicate other concerns.

On tab 2:  you can attach documents you want to have included with this form.  Click to prompt the upload screen and navigate to the document you want to add. Use the to remove documents you no longer want uploaded. An example would be signature pages.