for Chronic Fatigue Syndrome, Fibromyalgia, and Orthostatic Intolerance
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Sample 504 Plan and IEP 

for a 7th Grade Student with CFS




 

CENTRAL SCHOOL DISTRICT

SECTION 504

STUDENT ACCOMODATION PLAN




Student:                                               Grade:  7          Date of Birth:
School:                                                 Date of Meeting:



  1. Describe the nature of the concern:
    “Student’s Name” has been diagnosed as having Chronic Fatigue Immune Dysfunction Syndrome (CFIDS), which is recognized as a debilitating medical condition.
  2. Describe the basis for the determination of handicap (if any):
    “Student’s Name” diagnosis has been made by Dr. David Bell, a medical expert on CFIDS.
  3. Describe how the handicap affects a major lifeactivity:
    “Student’s Name” is unable to attend school for a full day and/or on a regular basis. His/her academic program is limited and determined by his/her daily health status
  4. Describe the reasonable accommodations that are necessary:

    1. Home tutoring: 2 hours/dayfor 5 days/week
    2. Books On Tape
    3. Use of calculator, wordprocessor, and tape recorder for homework assignments
    4. Testing Modifications: Extended time limits; test questions read; tests blownup to large print; tests divided into and presented in smaller parts; demonstrate mastery with less questions; use of calculator

Review/Assessment Date: Month Year



Participants (Name and Title)
Jane Smith, mother Kate Jones, School Counselor
John Smith, father Dave Frank, School Psychologist
Joe Doe, principal


Attachments: Information regarding Section 504 of the Rehabilitation Act of 1973; Parent/Student Rights in Identification, Evaluation and Placement




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