ࡱ> IKH!` %bjbj\\ ..>>FdNNN8<$ (2J<"^^^= ] X'''''''$)h(,n(E9=(^^H(   8^^' '  V&@'^ -N%' '^(0(1'x,,','4a>, $ aaa(( aaa( N N$*B Section 504/ADA Student Accommodation Plan USD 308 Hutchinson, Ks 67501 Student:  FORMTEXT       Date:  FORMTEXT       School:  FORMTEXT       Date of Birth:  FORMTEXT       Next Review:  FORMTEXT       Part 1: Justification for Services Is the student disabled under Section 504?  FORMCHECKBOX YES  FORMCHECKBOX  NO The Student has a physical or mental impairment which substantially limits on or more of his/her major life activities.  FORMCHECKBOX YES  FORMCHECKBOX  NO If yes, please check:  FORMCHECKBOX caring for ones self  FORMCHECKBOX  hearing  FORMCHECKBOX performing manual tasks  FORMCHECKBOX speaking  FORMCHECKBOX walking  FORMCHECKBOX working  FORMCHECKBOX seeing  FORMCHECKBOX learning  FORMCHECKBOX  breathing  FORMCHECKBOX other:  FORMTEXT       Describe areas of need and action to be taken:  FORMTEXT       Briefly document the basis for determining the disability:  FORMTEXT       Area of Difficulty:  FORMTEXT       Accommodations:  FORMTEXT       Evaluation:  FORMTEXT       Area of Difficulty:  FORMTEXT       Accommodations:  FORMTEXT       Evaluation:  FORMTEXT       Area of Difficulty:  FORMTEXT       Accommodations:  ^dfz     2 4 6 @ B F ` d f z | ~ hR<5:CJ\jhR<>*Uj\hR<>*UjhR<>*UjthR<>*UjhR<>*UmHnHujhR<>*U hR<>*jhR<>*U hR<5\h-hR<5 Vf 8 c   ^  <]^` x]^x^ & Fxx @x$a$#%% 8 9 G H I N O ] ^ _     + , - D E S T U ^ _ m n o jXhR<U hR<CJ(jhR<UjphR<UjhR<UjhR<UjhR<UjhR<Uj,hR<UjhR<UjDhR<UjhR<UhR<2      6 8 : V X t v x   $ & ( 2 4 8 󽸫󽸏󽸂{ hR<5\j hR<>*Uj hR<>*UjhR<>*UmHnHujhR<>*U hR<>*jhR<>*Uj,hR<UjhR<Uj@hR<UjhR<UhR<jhR<U0  6 8 ,tL$ d HJLdfz|~մէ՚ՍՀj hR<>*UjB hR<>*Uj hR<>*UjZ hR<>*Uj hR<>*Ujr hR<>*U hR<5\ hR<>*jhR<>*UmHnHujhR<>*Uj hR<>*U2    " $ < > R T V ` b !!*!,!.!8!:!d!f!z!|!~!!!!!!!jnhR<>*UjhR<>*UjhR<>*UjhR<>*Uj hR<>*UjhR<>*UmHnHuj* hR<>*UUjhR<>*U hR<5\ hR<>*4FORMTEXT       Evaluation:  FORMTEXT       Area of Difficulty:  FORMTEXT       Accommodations:  FORMTEXT       Evaluation:  FORMTEXT       Area of Difficulty:  FORMTEXT       Accommodations:  FORMTEXT       Evaluation:  FORMTEXT       I give permission for my child to receive the above mentioned services. ___________________________________________________________ __________________ Parent s signature Date     PAGE  PAGE 1 USD 308 does not discriminate on the basis of race, religion, color, national origin, sex, age, or disability in employment or in access to or the use of its programs and activities. Section 504  5 Rev. 1-6-06 !!!!!!!!""""""#########################H%%%%νvkhx0hx0CJaJ&h_hd`|56CJOJQJ^JaJhd`|0JmHnHuhhhx0 hx00Jjhx00JUhd`|h_jh_UhR<jVhR<>*U hR<5\ hR<>*jhR<>*UmHnHujhR<>*UjhR<>*U*!!""""T###############H%%%%$a$gdd`| &`#$gdh]x]]%%%%]%%hR<,1h/ =!"#$% tDText1tDText2tDText3tDText4tDText5tDeCheck1tDeCheck2tDeCheck1tDeCheck2tDeCheck3tDeCheck4tDeCheck5tDeCheck6tDeCheck7tDeCheck8tDeCheck9vDeCheck10vDeCheck11vDeCheck12tDText6tDText7tDText8tDText9tDText9tDText9tDText9tDText9tDText9tDText9tDText9tDText9tDText9tDText9tDText9tDText9tDText9tDText9@@@ NormalCJ_HaJmH sH tH D@D Heading 1$$x@&a$5\F@F Heading 2 $x@& 5:CJ\DA@D Default Paragraph FontVi@V  Table Normal :V 44 la (k@(No List :>@: Title$a$ 5:CJ \PC@P Body Text Indent`x^``DT@D Block Textx]^4 @"4 x0Footer  !.)@1. x0 Page Number4@B4 x0Header  !. z z(+3IJK  8c^ WX:Z2Z~  ST0*0*0*0*0*0*0*0*0*0*0*0*0*0*0*0*0*0*0*0*0*0*0*0*0*0*0*0*0*0*0*0*0*0*0*0*0*0*0*0*0*0*0*0*0*0*0*0*0*0*0*y0*v:0*j+3IJK  8c^ WX:Z2Z~  ST000000000000 00000000000000 0@0@0@0@0@0@0@0@0@0@0@0@0@0@0@0@0@0@0@0@0@0@0@00000000000000@0@0000I00  !%%  !%% % T`fo{8HN^,DT^n +;COU&28FRXnz *0FRXjv|FtFtFtFtFtG G G G G G$G$G$G$G$G$G$G$G$FtFtFtFtFtFtFtFtFtFtFtFtFtFtFtFtFtFt  !!8@0(  B S  ?Text1Text2Text3Text4Text5Check1Check2Check3Check4Check5Check6Check7Check8Check9Check10Check11Check12Text6Text7Text8Text9Up9OE_ ,D gI_-Uo<V*l*-**tl33?C=AHH9*urn:schemas-microsoft-com:office:smarttagsState>*urn:schemas-microsoft-com:office:smarttags PostalCode8 *urn:schemas-microsoft-com:office:smarttagsCity9 *urn:schemas-microsoft-com:office:smarttagsplace CHKRTgo8IN_-CV&9FYn1FYj} Tgo8IN_-3oy'CV&9FYn1FYj} 33333/23=EHRRSgn8IN_-STmn:;CV%9DDEYZ kS*s=:p<J\8OlOh^`CJOJQJo(qh ^`OJQJo(oh pp^p`OJQJo(h @ @ ^@ `OJQJo(h ^`OJQJo(oh ^`OJQJo(h ^`OJQJo(h ^`OJQJo(oh PP^P`OJQJo(h^`.h^`.hpLp^p`L.h@ @ ^@ `.h^`.hL^`L.h^`.h^`.hPLP^P`L.hhh^h`o(.h^`.hpLp^p`L.h@ @ ^@ `.h^`.hL^`L.h^`.h^`.hPLP^P`L.J\kS*s=:                  hH        R<d`|_hx0-]@\@pp@p pp UnknownGz Times New Roman5Symbol3& z Arial;Wingdings?5 z Courier New"1hf*&f*&  #4d3qHP)?d`|2SECTION 504 REFERRALUSD 308USD 308   Oh+'0$ 4@ ` l x SECTION 504 REFERRALUSD 308(5-SECTION 504 Student Acomodation PlanUSD 3081Microsoft Office Word@@@ӝ@ӝ՜.+,0 hp  USD480 d SECTION 504 REFERRAL Title  "#$%&'()*+,-./012345679:;<=>?ABCDEFGJRoot Entry F/LData 1Table!,WordDocument..SummaryInformation(8DocumentSummaryInformation8@CompObjq  FMicrosoft Office Word Document MSWordDocWord.Document.89q