504 Summary of Performance

This form is provided to a student and their family at the completion of their educational program with the school district (usually upon graduation).

Date: The date the student is completing their educational program.

Disability: In a few words, identify the student's disability

Date of Initial Placement: Indicate the date the student was first placed on a 504.

Date of Last Evaluation: Indicate the date the student was last evaluated under Section 504.

The next section is three different textboxes.  You will want to summarize the assessment information in the first textbox, the student’s current academic achievement and functional performance in the second textbox and any recommendations for the student to meet their post-secondary goals in the third textbox.

Below is a screenshot of what the form looks like in print form.