504 form pdf 2022-2026

1. Click ‘Get Form’ to open the 504 form PDF in our platform's editor.
2. Begin by entering the student's name, date of birth, school name, and student ID number in the designated fields at the top of the form.
3. In the medical diagnosis section, select the appropriate diagnosis from the provided options and enter any relevant ICD-10 or DSM-V codes.
4. Indicate whether the condition is temporary by checking 'Yes' or 'No' and specify the estimated duration if applicable.
5. Complete the requested accommodations table by listing each diagnosis along with corresponding accommodations and expected duration. Be sure to detail how each diagnosis affects educational performance.
6. Fill in health care practitioner information, including their name, contact details, and signature. Ensure all required fields are completed for a valid submission.

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