504 Plan Documentation Template: Ensuring Equitable Educational Access

I. Student Information

*   Student's Full Name: Alex Johnson
*   Date of Birth: 08/15/2014
*   Grade Level: 5th Grade
*   School Name: Northwood Elementary School
*   School District: Maplewood Unified School District
*   Parent/Guardian Name: Sarah Johnson
*   Parent/Guardian Contact: (555) 123-4567, sarah.johnson@email.com

II. Disability Documentation and Eligibility Determination

*   Nature of Disability: Attention-Deficit/Hyperactivity Disorder (ADHD), Combined Presentation.
*   Impact on Major Life Activities: Alex's ADHD substantially limits the major life activities of concentrating, learning, and executive functioning. This manifests as difficulty sustaining attention during instruction, organizing tasks, and managing time effectively.
*   Supporting Documentation: A comprehensive evaluation from Dr. Emily Carter, a licensed child psychologist, dated 10/20/2025, confirms the diagnosis and its educational impact. Teacher observations and academic records also support this determination.
*   Date of Eligibility Determination: 11/05/2025

III. Team Members and Meeting Information

*   504 Team Members: Sarah Johnson (Parent), Mr. David Chen (5th Grade Teacher), Ms. Laura Davis (School Counselor), Mrs. Susan White (School Principal)
*   Date of Meeting: 11/10/2025
*   Parent/Guardian Consent: Sarah Johnson provided written consent for the implementation of this 504 Plan on 11/10/2025.

IV. Present Levels of Performance and Educational Needs

Alex is a bright and generally engaged fifth-grade student who, despite his intellectual capabilities, frequently struggles with academic tasks due to the manifestations of his ADHD. His primary challenges include difficulty sustaining attention during direct instruction and independent work, which often leads to incomplete assignments and inconsistent academic performance. Specifically, his grades in subjects requiring sustained focus, such as reading comprehension and multi-step math problems, tend to fluctuate. He also exhibits difficulties with executive functioning skills, including organizing his school materials, managing his time effectively, and initiating or completing multi-step projects without frequent redirection. These challenges impact his ability to fully access the general education curriculum and demonstrate his knowledge consistently. Therefore, the accommodations outlined in this plan are designed to mitigate these impacts and enable him to learn effectively alongside his peers.

V. Accommodations and Modifications

| Accommodation Type | Specific Accommodation | Detailed Rationale and Implementation |
|---|---|---|
| Instructional Accommodations | Extended time (1.5x) on tests and major assignments; preferential seating near the teacher and away from distractions; reduced homework assignments (e.g., odd-numbered problems only). | Rationale: Alex's ADHD impacts his processing speed and ability to sustain focus for extended periods, making it challenging to complete tasks within standard timeframes. Preferential seating minimizes visual and auditory distractions, aiding concentration. Reduced homework load addresses potential overwhelm and ensures the quality of work over quantity. Implementation: Teachers will proactively provide 1.5 times the standard time for all tests, quizzes, and projects. Alex will be seated in the front row, away from windows or high-traffic areas. Homework assignments will be modified to focus on key concepts, such as completing only odd-numbered problems or a selection of questions that demonstrate understanding. |
| Environmental Accommodations | Access to a quiet, alternative testing environment; frequent movement breaks (e.g., delivering a message, standing at desk) to help manage restlessness. | Rationale: A quiet environment reduces sensory input that can be distracting for students with ADHD, improving focus during high-stakes assessments. Frequent movement helps manage hyperactivity and restlessness, allowing Alex to return to tasks with renewed concentration. Implementation: For all major tests and quizzes, Alex will have the option to complete them in the school's resource room or another designated quiet space. Teachers will allow Alex to take short, pre-approved movement breaks (e.g., a quick walk to the water fountain, standing at his desk for a few minutes) as needed, without penalty, ensuring these do not disrupt the class. |
| Behavioral Accommodations | Consistent use of positive reinforcement for on-task behavior; instruction in self-regulation strategies (e.g., deep breathing); use of a visual schedule. | Rationale: Positive reinforcement encourages desired behaviors and builds self-esteem. Self-regulation strategies provide Alex with tools to manage his impulses and emotions. A visual schedule provides predictability and helps with transitions, which can be challenging for students with ADHD. Implementation: Teachers will implement a system of positive reinforcement, such as verbal praise, token economy, or a sticker chart, for demonstrating on-task behavior and task completion. The school counselor will work with Alex on identifying and practicing deep breathing exercises or other calming techniques. A daily visual schedule will be provided at his desk and reviewed at the start of each day and before transitions. |
| Technology Accommodations | Use of a word processor for written assignments; access to a calculator for math tasks when calculation is not the primary objective. | Rationale: A word processor can help Alex with legibility and organization of written work, reducing frustration related to handwriting difficulties or messy drafts. A calculator allows him to focus on mathematical concepts rather than being hindered by calculation errors, especially when the learning objective is problem-solving. Implementation: Alex will be permitted to use a computer or tablet with word processing software for all written assignments, including essays and reports. For math assignments and tests where the objective is conceptual understanding rather than arithmetic proficiency, he will have access to a calculator. |


VI. Related Services

None currently required.

VII. Review and Reevaluation Schedule

This plan will be reviewed annually by November 15th of each year. A comprehensive reevaluation will occur every three years.

VIII. Parent/Guardian Rights and Procedural Safeguards

Parents/Guardians have the right to receive notice, review records, and request an impartial hearing if they disagree with the school's decisions.

graph TD
    A[Student Identified] --> B{Medical Assessment}
    B --> C[AI Medical Scribe Documents Visit]
    C --> D[Clinical Documentation Agent Manages Records]
    D --> E{504 Plan Meeting}
    E --> F[Accommodations Defined]
    F --> G{Insurance & Prior Auth Handled by Agents}
    G --> H[Patient Data Management Centralizes Info]
    H --> I[Plan Implemented]
    I --> J{Ongoing Monitoring}
    J --> K[Plan Adjusted]
    K --> D