CLEVELAND

METROPOLITAN
SCHOOL DISTRICT
Eric S. Gordon
Chief Executive Officer

Section 504 Procedure Manual

The Cleveland Metropolitan School District respects and protects students’ right
to be free from unlawful discrimination on the basis of race, color, national origin,
citizenship status, religion, sex, sexual orientation, economic status, marital status,
pregnancy, age, or disability, in all decisions affecting admissions; membership in
school-sponsored organizations, clubs or activities; access to facilities;
distribution of funds; academic evaluations or any other aspect of school-
sponsored activities.

(Updated September 2013)

 TABLE OF CONTENTS

Section I Policy/Overview . . . . . . . . . . . . . . . . . . . . . . . . ... Page 3

Section II Definitions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Page 7

Section III Parent/Guardian/Student Rights . . . . . . . . . . . . . … Page 9

Section IV Referral . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Page 11

Section V Evaluation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Page 19

Section VI Section 504 Plan . . . . . . . . …………………. …. Page 20

Section VII Complaint Procedures . . . . . ………….. . . . . . . . . Page 27

Section VIII Mediations and Hearing Procedures . . . . . . . . . . . . Page 30

Forms
A. Section 504 Referral Form
B. Section 504 Notice to Parent
C. Section 504 Eligibility Form
D. Section 504 Plan
E. Section 504 Evaluation/Manifestation Determination Review
F. Section 504 Complaint Filing Form
G. Authorization to Release/Share Confidential Information
 POLICY
SECTION 504 OF THE REHABILITATION ACT OF 1973
AND THE ADA AMENDMENTS ACT

The Cleveland Metropolitan School District (“District”) will ensure that no student with a
disability as defined by Section 504 of the Rehabilitation Act of 1973 (Section 504) and the
Americans with Disabilities Act Amendments Act (ADAAA) within the District’s jurisdiction
will be denied, because of his/her disability, participation in curricular, intramural, or
interscholastic activities or any of the services offered or rendered regularly to the students of
this District. No otherwise qualified person shall, solely by reason of his/her disability, be
subjected to discrimination under any program or activity sponsored by the District. The District
is committed to ensure that students with disabilities be identified, evaluated, and provided with
a free appropriate public education. The District does not discriminate on the basis of disability
with regard to admission, access to education services, treatment or employment in its programs
and activities.

Effective January 1, 2009, the ADAAA also amended the Rehabilitation Act of 1973 such that
the definition of a disability under the Rehabilitation Act (29 U.S.C. 705) is the same as the
definition of a disability under the ADAAA (42 U.S.C. 12102). This policy incorporates the
amendments to the Americans with Disabilities Act.

The Board of Education directs the Chief Executive Officer to promulgate guidelines in
accordance with this policy.

Facilities/Program

The District’s educational program shall be equally accessible to all students at each grade level.
Barrier-free access to school facilities shall be provided to ensure that no individual with a
disability is denied an opportunity to participate in a District program available to persons
without disabilities. Students with disabilities shall have facilities of a type and quality
comparable to those of students without disabilities.

Identification, Evaluation and Placement

Identification/Child Find
The District shall make all reasonable efforts to identify students with disabilities who reside
within the District in order to determine possible eligibility for special education and/or related
services or supplementary aids and/or services in accordance with federal and state law and this
policy and procedures manual.

Evaluation
Any student who, because of a disability, needs or is believed to need special education or
related services, or is suspected of having a physical or mental disability which may substantially
limit a major life activity, may be referred for an evaluation. Evaluations must address the
concerns raised and the referral questions. As an example, if the suspected disability involves a
medical issue, evaluation may consist of consultation with the physician, identification of care
within the building and notification to others who may work with the child. All evaluation and
placement decisions will be made by a group of persons knowledgeable about the student, the
meaning of the evaluation data, and the placement options (Evaluation Team). When evaluating
a student to determine eligibility under Section 504, the assessment will not be limited to
whether the mental or physical impairment substantially limits the major life activity of learning.
The evaluation team shall not take into account the ameliorating effects of mitigating measures
(other than ordinary eyeglasses or contact lenses) used by a student when determining if the
student has a disability. A student may be eligible for a Section 504 plan if the student does not
require educational services but does require modifications to District policies, health services or
food services in order to participate in District programs and activities.

Parents and guardians shall be invited to participate in Section 504 meetings so as to have a
meaningful opportunity to provide input into Section 504 team decisions regarding the
identification, evaluation and placement of students with disabilities. If the District denies a
parental request for a Section 504 evaluation, it will provide with written notice of its procedural
safeguards.

Placement
A free appropriate public education shall be provided for each child determined to be qualified as
a student with a disability under Section 504. A qualified student with a disability shall be
placed in an educational setting with his/her non-disabled peers to the maximum extent
appropriate (“least restrictive environment” or “LRE”). If a student has an impairment that is
episodic in nature or in remission, the student is eligible for placement pursuant to Section 504 if
the impairment, when active, substantially limits one or more major life activities. If the
qualified student requires related aids and/or services in a regular education classroom, the
student’s principal, who is also the school building’s 504/ADAAA coordinator, shall involve the
student’s regular education teacher(s) in the Section 504 evaluation and placement process to
ensure that they:

A. Have knowledge of the law and the relationship between the student's disability and
his/her need for regular or special education and/or related aids and/or services;

B. Have knowledge of the student’s needs;

C. Ensure that the student’s individualized needs are met as adequately as the needs of
nondisabled students are met.

Hereafter, the policy will refer to Section 504 with the understanding that the ADAAA also
applies.

Reevaluation/Change in Placement

Section 504 requires a periodic meeting to review the plan’s efficacy and ongoing need.
Additionally, this allows the succeeding teachers and service providers an opportunity to learn of
the student’s needs and ensure that the plan is implemented at the beginning of each school year.
The District requires the student’s team, identified as persons knowledgeable of the student, to
conduct the periodic review annually.

An “evaluation” is required prior to a change of placement. Changes of placement would

include graduation and disciplinary removals in excess of ten (10) consecutive days. The

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evaluation requirement may be satisfied with the manifestation determination review according
to the guidelines promulgated pursuant to this policy.

Discipline

The discipline procedures described in the Student Code of Conduct shall be used in all situations
in which a qualified student with a disability under Section 504 (or suspected qualified disability)
may be subject to suspension or expulsion. Since expulsion or cumulative forms of suspension
may, in cases when the student will be excluded from school ten (10) or more days, constitute a
change in placement, a group of persons knowledgeable about the student, including the parent,
shall convene a meeting to discuss whether the behavior that led to the proposed disciplinary
action is directly and substantially related to the child’s disability. In this process, the team re-
evaluates the student. If the team’s determination is that the behavior leading to the proposed
disciplinary action is not a manifestation of the child’s disability then the child shall be
disciplined according to the Student Code of Conduct, the same as non-disabled students.

Enforcement

The District will utilize a general complaint procedure that incorporates the appropriate due
process standards and provides for the prompt and equitable resolution of alleged violations of
Section 504 by the District. The District has appointed a Section 504 Compliance Officer, who
is charged with interpreting Section 504/ADAAA and corresponding regulations on behalf of the
District, directing District policy and overseeing the provisions of this policy and procedure
manual. The Section 504 Compliance Officer reviews any alleged violations of Section 504
within the District. If it is deemed that a violation has occurred, the Section 504 Compliance
Officer will recommend corrective action for those violations directly to the Chief Executive
Officer (or designee).

Complaint Procedure

In accordance with Section 504 of the Rehabilitation Act of 1973 (Section 504), any student who
believes s/he has been the victim of discrimination or harassment (including bullying) based
upon disability or who believes s/he is entitled to or has been denied a free appropriate public
education to which s/he as a student with a disability is entitled, is encouraged to report the
alleged facts surrounding said treatment, entitlement or denial, within ten (10) days of the alleged
action to the Section 504 Compliance Officer. Any complaint alleging a violation of law and/or
this policy shall be investigated by or at the direction of the Section 504 Compliance Officer. In
addition to the Complaint Procedure set forth, alleged violations of Section 504 may be
challenged through an impartial due process hearing or reported to the United States Department
of Education, Office for Civil Rights at 600 Superior Avenue East, Suite 750, Cleveland, Ohio
44114-2611; Telephone: 216.522.4970; Facsimile: 216.522.2573; TDD: 877.521.2172; E-Mail:
OCR.Cleveland@ed.gov.

Program Evaluation and Compliance

The District shall evaluate its programs and practices on nondiscrimination and the provision of
services under Section 504, in accordance with federal law, and document its findings on an on-

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going basis and will adjust its practices as needed. The District shall submit assurance of
compliance as required by federal law.

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 DEFINITIONS

The Rehabilitation Act of 1973, 29 U.S.C. Sec. 794 et seq.:

Sec. 794
Nondiscrimination under Federal grants and programs;
“No otherwise qualified individual with a disability in the United States, as defined in Sec.
705(20) of this title, shall, solely by reason of her or his disability, be excluded from the
participation in, be denied the benefits of, or be subjected to discrimination under any program or
activity receiving Federal financial assistance or under any program or activity conducted by any
Executive agency or by the United States Postal Service.” (29 U.S.C. Sec. 794(a))

Individual with disability: Any individual who (A) has a physical or

mental impairment that substantially limits one or more
of the major life activities of such individual; (B) has a
record of such an impairment; or (C) being regarded as
having such an impairment. (42 U.S.C. 12102)

Major Life Activities: (A) Include, but are not limited to, caring for oneself,
performing manual tasks, seeing, hearing, eating, sleeping,
walking, standing, lifting, bending, speaking, breathing,
learning, reading, concentrating, thinking, communicating,
and working. (42 U.S.C. 12102)

(B) Major Bodily Functions include, but are not limited to,
functions of the immune system, normal cell growth,
digestive, bowel, bladder, neurological, brain, respiratory,
circulatory, endocrine, and reproductive functions. (42
U.S.C. 12102)

Substantially Limits: (A) An impairment that substantially limits one major life
activity need not limit other major life activities in order to
be considered a disability. (B) An impairment that is
episodic or in remission is a disability if it would
substantially limit a major life activity when active. (C) The
determination of whether an impairment substantially limits
a major life activity shall be made without regard to the
ameliorative effects of mitigating measures such as the
following examples: medication, medical supplies,
equipment, low-vision devices (which do not include
ordinary eyeglasses or contact lenses), prosthetics including
limbs and devices, hearing aids and cochlear implants,
mobility devices, or oxygen therapy equipment and
supplies, reasonable accommodations or auxiliary aids
and/or services. This list is not exhaustive.
Has a record of: Has a history of, or has been misclassified as having, a
mental or physical impairment that substantially limits one
or more major life activities.

Is regarded as: (A) has a physical or mental impairment that does not
substantially limit major life activities but that is treated by
a recipient as constituting such a limitation; (B) has a
physical or mental impairment that substantially limits
major life activities only as a result of the attitudes of
others toward such impairment; or (C) does not have a
physical or mental impairment but is treated by a recipient
as having such an impairment.

Transitory Impairment: The Act shall not apply to impairments that are transitory
and minor. A transitory impairment is an impairment with
an actual or expected duration of six (6) months or less.

The following definitions apply:

The Rehabilitation Act of 1973: Also referred to as Section 504

The Americans with Disabilities

Act Amendments Act: ADAAA, 42 U.S.C. 12101 et seq.

Individuals with Disabilities

Education Improvement Act: IDEIA, 20 U.S.C. 1401 et seq.

School Staff: A group of knowledgeable persons familiar with the

student and his/her needs. Within the District’s Section
504 policy and procedure manual, school staff may include,
but are not limited to, the school principal, psychologist,
general education teacher, guidance counselor,
administrative staff and nurse (if applicable).

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 SECTION 504 PROCEDURES MANUAL
ADMINISTRATIVE GUIDELINES

The Board of Education directs the Chief Executive Officer to promulgate these administrative
guidelines and procedures for implementation throughout the District.

The following is a description of the rights of District students with qualified Section 504
disabilities or those students suspected of having such disabilities. School staff are to ensure that
each student with, or suspected of having, a Section 504 disability, and her/his parent(s) are kept
fully informed concerning decisions about the student and about the student’s due process rights
in case the family disagrees with any decisions made by the District under Section 504.

It is important to note that when evaluating a student under Section 504, the student’s Section
504 team is to consider all appropriate assessments and that Section 504 prohibits the District
from categorically excluding any particular type of assessment from consideration.

District staff must ensure that parents of students are provided with Notice of
Parent/Guardian/Student Rights, which sets forth the following rights for parents of such
students:

NOTICE OF PARENT/GUARDIAN/STUDENT RIGHTS

Notice, and other procedural safeguards, shall be provided to parent(s) and guardian(s) with
respect to actions regarding the identification, evaluation or educational placement of students
with disabilities. Below is a description of the rights granted by Federal law to individuals with
disabilities. It is the intent of Section 504 of the Rehabilitation Act of 1973 to keep you fully
informed concerning decisions about your child and to inform you of your rights if you disagree
with any of these decisions.

You have the right to:

a) Have your child take part in, and receive benefits from public education programs
without discrimination because of his/her disability.
b) Have the District advise you of your rights under Federal law.
c) Receive notice with respect to identification, evaluation, or placement of your child.
d) Have your child receive a free appropriate public education that consists of regular or
special education and related aids and/or services designed to meet the student’s needs as
adequately as the needs of nondisabled students are met. This also includes the right to be
educated with non-disabled students to the maximum extent appropriate.
e) Have your child educated in facilities and receive services comparable to those provided
non-disabled students.
f) Have your child receive special education and related services if s/he is found to be
eligible under Individuals with Disabilities Education Improvement Act, and/or regular or
special education and related aids and/or services under Section 504.
g) Have evaluation, educational, and placement decisions made based upon a variety of
information sources, and by persons who know the student, and are knowledgeable about
the evaluation data and placement options, including the child’s parents.
h) Have transportation provided to and from an alternative setting at no greater cost to you
than would be incurred if the student were placed in a program operated by the District
 and not in addition to any cost normally charged to a student without a disability for such
transportation.
i) Have your child be given an equal opportunity to participate in nonacademic and
extracurricular activities offered by the District.

j) Examine all relevant records relating to decisions regarding your child’s identification,
evaluation, education program, and placement.
k) Obtain copies of educational records at a reasonable cost unless the fee would effectively
deny you access to the records, the same as for all individuals requesting such records.
l) A response from the District to reasonable requests for explanations and interpretations of
your child’s records.
m) Request amendments of your child’s educational records if there is reasonable cause to
believe that information contained in the record(s) is inaccurate, misleading or otherwise
in violation of the privacy rights of your child. If the District refuses to amend the
record(s), you have the right to request a hearing and/or to place in the record a statement
of why you disagree with the information it contains.
n) Request mediation or an impartial due process hearing related to decisions or actions
regarding your child’s identification, evaluation, educational programs, or placement.
You and your child may take part in the hearing and be represented. Hearing requests
must be made to the Section 504 Compliance Officer.
o) Receive all information in the parent’s native language and mode of communication.
p) File a local grievance or a complaint with the Office for Civil Rights at any time

The District’s Section 504 Compliance Officer, the person in the District responsible for assuring
that the District complies with Section 504 is:

Wayne J. Belock, Esq.

Section 504 Compliance Officer
Cleveland Metropolitan School District
1111 Superior Avenue East, Suite 1800
Cleveland, Ohio 44114
Phone: (216) 838-0070
E-mail: Wayne.Belock@clevelandmetroschools.org

The Office for Civil Rights of the United States Department of Education enforces the
requirements of Section 504 of the Rehabilitation Act of 1973. The address of the Ohio Office is:

Office for Civil Rights, Cleveland Office Telephone: 216.522.4970

U.S. Department of Education Facsimile: 216.522.2573
600 Superior Avenue East, Suite 750 TDD: 877.521.2172
Cleveland, Ohio 44114-2611 E-Mail: OCR.Cleveland@ed.gov.

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 REFERRAL

Section 504 Referral Form

It is the responsibility of the District to identify and evaluate students who, within the intent of
Section 504 of the Rehabilitation Act of 1973, require regular or special education and related
aides and/or services in order to receive a free appropriate public education (FAPE).

Any student who needs, or is believed to need, accommodations or services not available through
existing programs in order to receive a free appropriate public education may be referred by a
parent, teacher, or a third party for identification and possible evaluation of the student’s
individual educational needs.

The school principal is the school building’s Section 504 coordinator and shall have ample
referral forms (FORM A) available in the main office for parents, teachers and other individuals
who request them.

The Section 504 Referral Form (FORM A) must be submitted directly to the school principal and
the principal shall sign the original form upon receipt and make three (3) copies. A copy shall be
forwarded to (1) the school psychologist; (2) the Section 504 Compliance Officer; and (3) the
parent. The original shall be placed in the student’s permanent educational file located in the
main office.

Upon referral for an evaluation, the parent/legal guardian, or student if over 18, shall also be
provided with a copy of the description of rights granted by the federal law to students with
disabilities.

SECTION 504 REFERRAL PROCEDURES

If a parent or school staff member suspects that a child may have a disability and may be entitled
to special accommodations and/or services under Section 504, the principal shall follow these
procedures:
 PROCEDURE PERSON FORMS (S)
RESPONSIBLE
1. INITIAL REFERRAL FOR SECTION 504 EVALUATION Section 504
Referral Form
(When a parent refers a child for a Section 504 evaluation) (FORM A)

A parent may verbally or in writing request a Section 504 evaluation

to the child’s teacher, principal, other administrative staff, school
nurse, school psychologist, school social worker or guidance The staff
counselor. member
receiving the
• If the parent requests a 504 evaluation, then the staff member verbal or
must immediately inform the parent that the parent must fill out written request
a “Referral Form” and that, upon completion, the form must be
given directly to the principal.

• If the parent requires assistance in writing the referral, the staff Parent
member shall assist the parent in filling out the referral form, Section 504
whether or not the staff member agrees with the grounds for the Referral Form
referral. (FORM A) &
Principal Section 504
(Referrals from third parties) Notice to
Parents w/ 504
When a third party submits a written referral for a Section 504 Procedural
Evaluation, the child’s parent/legal guardian must be notified of the Safeguards
referral. If the referral is given to the teacher, then that teacher must (FORM B)
immediately forward the form to the principal (or designee) for
action.
POST REFERRAL
2. The principal signs and dates the referral. Three copies of the
referral are made and within a reasonable time, the principal gives a Principal
copy of the referral to the
1. parent
2. school psychologist
3. District Section 504 Compliance Officer
The original form is placed in the student’s permanent educational
file.
INITIAL DETERMINATION OF SUSPICION
3. An initial determination is made with deference given to the parent,
psychologist and nurse (if applicable), whether the school suspects Principal Section 504
that the child has a present disabling condition that substantially Notice to
limits a major life activity. A doctor’s statement does not make the Parents w/ 504
child eligible for a 504 plan. It can be used in conjunction with all Procedural
data to be reviewed in the team determination. Safeguards
The principal, upon consultation with the parent, teacher, school (FORM B)
psychologist, guidance counselor (if applicable), the child’s doctor
and/or school nurse (if applicable) forwards a Section 504 Notice to
Parents with 504 Procedural Safeguards indicating whether or not
the school suspects the child has a present disabling condition that
substantially limits a major life activity.

If the child has gone through the IDEIA referral and evaluation
12
 process and is deemed ineligible under IDEIA, the child does not
need to start over at the referral stage for Section 504. Current
evaluation data can assist in the determination of 504 eligibility.

If the school team does not suspect that the child has a disability that
substantially limits a major life activity, then the team is not
obligated to move forward with a full Section 504 evaluation. The
school team should provide the parent with procedural safeguards.
EVALUATION & ELIGIBILITY DETERMINATION

If the school team does suspect that the child may be qualified under Principal & Section 504
Section 504, the team must move forward with a full Section 504 Section 504 Notice to
evaluation within sixty (60) days of receipt of parental consent to school team Parents with 504
conduct the evaluation. The school team shall make efforts to Procedural
include the parent and shall include at least one of the child’s Safeguards
general education teacher(s), the school psychologist and school (FORM B)
nurse (if applicable) and other applicable support staff, i.e.,
audiologist, PT, SLP,OT.

Parent/legal guardian shall be notified in writing of the Section 504

team meeting to determine eligibility under Section 504.
If the student is found to be eligible, the school team
should determine if development of a Section 504 plan is
necessary at this time.
If the student is found to be not eligible, the school team
should provide parent with procedural safeguards.

SECTION 504 PLAN

4.
Consent of parent/legal guardian is obtained for implementation of Principal Section 504
the plan. Evaluation and
Plan (FORM D)
5.
After the Section 504 evaluation meeting, the principal shall make Principal
four (4) copies of the Section 504 Evaluation and Plan and give a
copy to:
1. parent
2. the child’s general education teacher(s)
3. school psychologist and/or nurse (if applicable)
4. Section 504 Compliance Officer, Legal Services Dept.
5. student’s permanent educational file (original)

6. General Section 504

Section 504 plan is implemented with periodic review, at least Education Evaluation and
annually. Teacher and Plan (FORM D)
designated
team members

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 FORM A
SECTION 504 REFERRAL FORM

THIS REFERRAL MUST BE GIVEN TO THE PRINCIPAL UPON COMPLETION

This referral is being made by: parent/legal guardian, teacher, principal, other (circle one)

I. STUDENT’S PERSONAL INFORMATION

ID/SS#:
Student: Date of Birth:
Parent/Guardian: Phone(s):
Address: School:
Teacher: Grade:
Referred by: Referral Date:

II. BACKGROUND INFORMATION:

A. Reason for Referral:

B. Indicate which major life activity(s) appears to be limited:

□ caring for self □ eating □ seeing □ hearing

□ sleeping □ breathing □ standing □ speaking
□ communicating □ concentrating □ perform manual tasks □ walking
□ lifting □ bending □ learning □ reading
□ immune system function □ respiratory function □ normal cell growth □ thinking
□ digestive function □ bladder function □ neurological function □ working
□ circulatory function □ reproductive function □ endocrine function □ brain function
□ other (please describe_______________________)

C. Indicate specifically how the major life activity(s) is being limited.

D. Indicate how significant the major life activity(s) is being limited:

□ Mildly □ Moderately □ Substantially

E. Strategies/interventions to date (attach copies of documentation):

F. List all medications or devices that are currently being used by the student.
_________________________________________________________________________________

G. Attach any additional information (i.e. previous evaluations, medical reports, state/district-wide tests)

Page 1 of 2
 By signing below, I acknowledge receipt of a copy of this referral and a copy of the Notice of
Parent/Guardian/Student Rights
I further understand that, as parent or guardian, my signature also acts as my written consent
to initiate a full Section 504 evaluation.

________________________________________ _______________________________________
*Parent (or person making referral) Date

THIS REFERRAL MUST BE:

Provided to the principal

Signed by the principal
Copied and provided to the parent
Copied and provided to the Section 504 Compliance Officer and Executive Director, Intervention Svcs.
Placed in the student’s permanent educational file

________________________________________ _______________________________________
*Signature of Principal Date of referral receipt

If the school team finds it necessary to obtain relevant information regarding the student
from outside providers, please complete a Authorization to Release/Share Confidential
Information (FORM G) and secure parent/legal guardian signature.

Page 2 of 2

15
 FORM B
SECTION 504 NOTICE TO PARENT
(This form serves as the response to the parent of the District’s initial determination of eligibility)

STUDENT’S PERSONAL INFORMATION

ID/SS#:
Student: Date of Birth:
Parent/Guardian: Phone(s):
Address: School:
Teacher: Grade:
Referred by: Referral Date:

____ Notice to Parent or legal guardian of the Section 504 Referral Form (FORM A) Your child has been referred to
the Section 504 School Team because of a concern that he/she may have a physical or mental disability that substantially
limits a major life activity.

____ Notice to Parent of initial determination. The principal, upon consultation with the school psychologist and/or
nurse, has reviewed the referral and the provided documentation. The review may have also included consideration of your
child’s permanent educational file and consultation with his or her teachers, the school counselor, you, your child, your
child’s doctor and/or other professionals.

The following initial determination has been made:

Your child DOES NOT have a suspected mental, medical, or physical disability that substantially limits a major
life activity and requires further evaluation for qualification under Section 504. The referral and documentation
reviewed is insufficient to warrant a suspected disability. However, your child may be referred to the school’s
Student Support
Intervention Team
Based (SST) forteam
Assessment general education
(IBA) interventions.
for general education interventions.

The District DOES suspect that your child may have a mental, medical, or physical disability that requires
further evaluation for possible determination of eligibility under Section 504.

You are invited to a team meeting on (day)_______________________, (date)__________________________,

201______ at (time)________________. The meeting will take place in room _____________.

Upon review of your child’s referral and supporting documentation, your child may have a suspected
disability that adversely impacts educational performance and requires special education and/or related
services. Your child has been referred to the SST for interventions and a possible referral for a
multifactored evaluation.

Your child’s Section 504 school team determined at the evaluation meeting and periodic review on
_____________ that your child NO LONGER QUALIFIES for a Section 504 Plan and has
terminated the plan.
Please be advised that you have procedural due process rights by which to challenge this determination. A notice
of these rights are attached to this notice.

_________________________________ _________________________________________
Signature of Principal Date forwarded to parent with Procedural Safeguards
 Notice of Parent/Guardian/Student Rights

Below is a description of the rights granted by Federal law to individuals with disabilities. It is the
intent of Section 504 of the Rehabilitation Act of 1973 to keep you fully informed concerning decisions
about your child and to inform you of your rights if you disagree with any of these decisions.

You have the right to:

a) Have your child take part in, and receive benefits from public education programs without
discrimination because of his/her disability.
b) Have the District advise you of your rights under Federal law.
c) Receive notice with respect to identification, evaluation, or placement of your child.
d) Have your child receive a free appropriate public education that consists of regular or special
education and related aids and/or services designed to meet the student’s needs as adequately as
the needs of nondisabled students are met. This also includes the right to be educated with non-
disabled students to the maximum extent appropriate.
e) Have your child educated in facilities and receive services comparable to those provided non-
disabled students.
f) Have your child receive special education and related services if s/he is found to be eligible
under Individuals with Disabilities Education Improvement Act, and/or regular or special
education and related aids and/or services under Section 504.
g) Have evaluation, educational, and placement decisions made based upon a variety of information
sources, and by persons who know the student, and are knowledgeable about the evaluation data
and placement options, including the child’s parents.
h) Have transportation provided to and from an alternative setting at no greater cost to you than
would be incurred if the student were placed in a program operated by the District and not in
addition to any cost normally charged to a student without a disability for such transportation.
i) Have your child be given an equal opportunity to participate in nonacademic and extracurricular
activities offered by the District.
j) Examine all relevant records relating to decisions regarding your child’s identification,
evaluation, education program, and placement.
k) Obtain copies of educational records at a reasonable cost unless the fee would effectively deny
you access to the records, the same as for all individuals requesting such records.
l) A response from the District to reasonable requests for explanations and interpretations of your
child’s records.
m) Request amendments of your child’s educational records if there is reasonable cause to believe
that information contained in the record(s) is inaccurate, misleading or otherwise in violation of
the privacy rights of your child. If the District refuses to amend the record(s), you have the right
to request a hearing and/or to place in the record a statement of why you disagree with the
information it contains.
n) Request mediation or an impartial due process hearing related to decisions or actions regarding
your child’s identification, evaluation, educational programs, or placement. You and your child
may take part in the hearing and be represented. Hearing requests must be made to the Section
504 Compliance Officer.
o) Receive all information in the parent’s native language and mode of communication.
p) File a local grievance or a complaint with the Office for Civil Rights at any time.
The District’s Section 504 Compliance Officer, the person in the District responsible for assuring that
the District complies with Section 504, is:

Wayne J. Belock, Esq.

Section 504 Compliance Officer
Cleveland Metropolitan School District
1111 Superior Avenue East, Suite 1800
Cleveland, Ohio 44114
Phone: (216) 838-0070
E-mail: Wayne.Belock@clevelandmetroschools.org

The Office for Civil Rights of the United States Department of Education enforces the requirements of
Section 504 of the Rehabilitation Act of 1973. The address of the Ohio Office is:

Office for Civil Rights, Cleveland Office

U.S. Department of Education
600 Superior Avenue East, Suite 750
Cleveland, Ohio 44114-2611
Telephone: 216.522.4970
Facsimile: 216.522.2573
TDD: 877.521.2172
E-Mail: OCR.Cleveland@ed.gov

THIS NOTICE TO PARENT MUST BE:

Provided to the Parent

A copy placed in student’s permanent educational record
Forwarded to the Section 504 Compliance Officer and Executive Director, Intervention Services

18
 EVALUATION

Section 504 Evaluation Team Report

SECTION 504 EVALUATION

Any student who needs or is believed to need regular or special education and related aids and/or
services under the auspices of Section 504 of the Rehabilitation Act of 1973 may be referred to the
Section 504 School Team for evaluation.

The Section 504 School Team shall be composed of persons knowledgeable about the student’s school
history, the student’s individual needs, the meaning of evaluation data, and options that will enable the
student to attain access to educational opportunities.

The student’s parent(s) shall be notified of, and invited to participate in, the Section 504 School Team
meeting within a reasonable amount of time (or approximately two (2) weeks) prior to the meeting.

Any tests used for the purpose of qualifying a student under Section 504 shall be selected and
administered so as best to ensure that the test results accurately reflect the student’s aptitude or
achievement or other factors being measured rather than reflect the student’s disability, except where
those are the factors being measured. All evaluation materials must be tailored to evaluate the specific
areas of educational need and not merely those designed to provide a single intelligence quotient. The
tests and other evaluation materials must be validated for the specific purpose for which they are used
and appropriately administered by trained personnel.

The Section 504 School Team shall consider all relevant information on the student to determine
whether s/he has a disability under Section 504 from a variety of sources. Information may include
reports from outside physicians; observations from parents, teachers, and school personnel; results of
standardized tests; and other documents that may have relevance.

Should the Section 504 School Team determine that a student has a disability under Section 504, it will
develop a Section 504 Plan (FORM D)describing what accommodations or special education and related
aids and/or services are required to meet the student’s individualized needs as adequately as the needs of
nondisabled students are met.

The Section 504 School Team shall invite the parent(s)/guardian(s) to participate in the meeting where
recommendations are made.

If a plan for providing services is developed, all school personnel who work with the student shall be
informed of the plan.

Evaluation of the student and formulation of a plan of services implemented by the Section 504 school
team will be implemented according to the following procedures:

An individualized evaluation will be conducted in the native language of the student.

The Section 504 school team will evaluate the nature of the student’s disability and the impact of the
disability upon the student’s education. This evaluation will include consideration of any behaviors that
interfere with regular participation of a student who otherwise meets the criteria (such as age) for
participation in the educational program and/or activities.
The Section 504 School Team, in writing, will make the final decision, and the parent(s) or guardian(s)
of the student shall be notified of the Section 504 procedural safeguards available to them, including the
right to an impartial due process hearing and review.

REVIEW/REEVALUATION OF STUDENT’S PROGRESS

The Section 504 School Team will monitor the effectiveness of the student’s Section 504 Plan
periodically and, at a minimum of every three (3) years, conduct a reevaluation. A reevaluation also will
be conducted prior to any subsequent significant change in the student’s placement.

IMPLEMENTATION OF SECTION 504 PLANS

The identified school staff must implement the provisions of Section 504 plans for those students for
whom the teacher is responsible. Failure to implement a Section 504 plan may be considered
discrimination on the basis of a disability with potential consequences imposed by the U.S. Department
of Education, Office for Civil Rights, and/or an Impartial Hearing Officer.

REGULAR EDUCATION INTERVENTION PLAN

A regular education intervention plan is appropriate for a student who does not have a disability or is not
suspected of having a disability but may be facing challenges in school. Student Support Teams (SSTs)
are designed to provide regular education teachers with support and strategies for helping students in
need of various accommodations and assistance. Regular Education Intervention Plans are not policed
by the U.S. Department of Education, Office for Civil Rights.

SECTION 504 PLAN

SECTION 504 PLAN

The Section 504 School Team will develop a written plan describing the disability and the
accommodations or special education and related aids and/or services needed. The plan will specify
how the accommodations or special education and related aids and/or services will be provided, and by
whom.

The parent(s) or guardian(s) shall be invited to participate in Section 504 School Team meetings where
the student’s Section 504 Plan will be developed or modified, and shall be given an opportunity to
examine all relevant records.

The team may also determine that no accommodations, special education or related aids and/or services
are appropriate at present. If so, the record of the Section 504 School Team proceedings will reflect the
determination of the student as a person with or without a qualified disability and will state the basis for
the decision that no accommodations, special education or related aids and/or services are needed at this
time. If the student is eligible but not presently requiring accommodations, special education or related
aids and/or services, possibly due to a disability in remission, the Section 504 school team will provide
notice to the parent/guardian to that effect with a plan to convene and implement Section 504 Plan, as
necessary.

Even if no accommodations, special education or related aids and/or services are appropriate at this time
due to the disability being in remission or the efficacy of auxiliary aides and services, the Section 504
disciplinary protections would still apply to the student. In addition to the disciplinary protections, the

20
student is also covered by the nondiscrimination provisions of Section 504, which includes being
protected from harassment based on disability, as well as Section 504’s retaliation prohibition.

A qualified student with a disability under Section 504 shall be placed in the regular educational
environment within the District, with the use of related aids and/or services, unless the District
demonstrates that such placement cannot be achieved appropriately. The student with a qualified
disability shall be educated with those students who are not disabled to the maximum extent appropriate
based on the individual needs of the student.

21
FORM C
Section 504 Eligibility Form
Conference Date: ___________________________
Student Name: _____________________________ DOB: __________________________
School: ___________________________________ Grade: _________________________
Student Address: _______________________________________________________________
Parent Name: ______________________________ Phone #: ________________________

_____ The Notice of Parent/Guardian/Student Rights distributed on: ______________________________

_____ The parent/guardian was invited but did not attend. Notice of Rights was mailed on: ____________

Type of Evaluation: _____ Initial _____Re-evaluation/annual review _____ Case Review

Background Information/Reason for Referral:

___________________________________________________________________________________________
_________________________________________________________________

Sources of information considered by team to determine eligibility: (check all that apply)
_____ Parent Recommendation _____ Physician Diagnosis _____ Educ/Psych Evaluation
_____ Teacher Recommendation _____ Aptitude/Achievement Tests _____ Standardized Tests
_____ Adaptive Behavior _____ Other: _______________________________________

Section 504 Team Determinations:

1. The student has a mental or physical impairment. _____ Yes _____ No
a. If yes, what is the impairment? (DSM IV or other source, if not excluded; i.e., illegal drug use)
____________________________________________________________________

b. If no, the student is not eligible for regular or special education and related aids and/or services under
Section 504. The child may be eligible for classroom interventions.

2. If the student has an impairment in #1, the impairment must substantially limit a major life activity. Please
consider the following (non-exclusive) list of questions in making a determination:

Yes No Has the student demonstrated a consistent need for substantially more time to complete
class and/or homework assignments?
Yes No Does the student consistently need modified testing to be able to demonstrate his/her
knowledge?
Yes No Does the student have significant difficulty with planning, organization and performing
school-related assignments or other activities?
Yes No Is the student chronically absent or tardy due to a physical or mental impairment?
Yes No Does the student exhibit frequent behaviors (such as impulsivity, inattentiveness,
aggression, drowsiness) that are commonly associated with the student’s physical or
mental impairment or the medication that the student is taking?
Yes No Has the student experienced a significant decline in academic performance that is not due
to any cause other than a physical or mental impairment?
Yes No Does the student have significant discipline problems that are not due to any cause other
than the physical or mental impairment?
Yes No Does the student continue to exhibit difficulties with academic performance/progress
despite receiving consistent intervention strategies?

Does the student’s physical or mental impairment limit his/her ability to learn in any manner not already
indicated? _____ Yes _____ No If so, please explain: _________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
The student’s impairment is limiting a major life activity in the following way:
_____ Mildly _____ Moderately _____ Substantially

List all medications or devices (such as hearing aids, glasses, etc.) that are currently being used by the student.
While important to note, these mitigating measures are no longer considered in determining eligibility.
______________________________________________________________________________
______________________________________________________________________________

The Section 504 Team has evaluated the student and determined:

_____ The student DOES NOT have a mental, medical, or physical disability that substantially limits one or
more major life activities. The student is not an eligible student under Section 504.

□ The student should be referred to the SST for development of classroom interventions.

_____ The student DOES have a mental, medical, or physical disability that substantially limits one or more of
the following major life activities:

□ caring for self □ eating □ seeing □ hearing

□ sleeping □ breathing □ standing □ speaking
□ communicating □ concentrating □ perform manual tasks □ walking
□ lifting □ bending □ learning □ reading
□ immune system function □ respiratory function □ normal cell growth □ thinking
□ digestive function □ bladder function □ neurological function □ working
□ circulatory function □ reproductive function □ endocrine function □ brain function
□ other (please describe_______________________)

□ The student will have a Section 504 Plan developed.

□ The student is determined eligible under Section 504 however, at this time, does not require a Section
504 Plan. Send Prior Written Notice to parent. Discipline protections still apply.

_____ The student DOES have a mental, medical, or physical disability that substantially limits one or more
major life activity and will be referred for a multi-factored evaluation under the Individuals with Disabilities
Education Improvement Act of 2004.

Section 504 Team Members Check Areas of Knowledge

Name Title Child Evaluation Data Accommodation/Placement

*Adapted with permission from Perry A. Zirkel, Author of Section 504, the ADA and the Schools.

23
FORM D
Section 504 Plan
Conference Date: ___________________________
Student Name: _____________________________ DOB: __________________________
School: ___________________________________ Grade: _________________________
Student Address: ________________________________________________________________
Parent Name: ______________________________ Phone #: ________________________

Type of Plan: _____ Initial _____Re-evaluation/annual review _____ Case Review _____ *Monitoring only

Strategies/Interventions attempted to date:

___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________

Substantial Limitation/Major Life Activity

Accommodations, Modifications, Related Aids and/or services

Individual(s) Responsible for Implementation & Monitoring

Location

Date of Initiation of Services – Date of Review

Academic, Non-Academic, Extracurricular – if applicable

All necessary individuals have been informed of this plan. □ Yes □ No

*A “monitoring only” plan would be used for eligible students whose disability does not require any
accommodations, special education or related aides and/or services at this time.
 Section 504 Team Members
Name Title

I have been informed of the Section 504 Plan for my child and have received a copy of the Notice of
Parent/Guardian/Student Rights.

Parent/Guardian Signature _____________________________________________________

Date ______________________________________________________________________

Original placed in student permanent record

Copies to: Parent/Guardian
Identified school staff
Principal
Section 504 Compliance Officer
Executive Director, Intervention Services

25
FORM E
SECTION 504 EVALUATION/MANIFESTATION DETERMINATION REVIEW

Student’s Name: ID# Grade:_______DOB:___/___/___

Last, First

Principal, 504 Coordinator: ____________________________ Date of Evaluation: ______________________

Upon consideration of a change of placement due to discipline, the Section 504 Team must conduct an evaluation
including review of pertinent information from a variety of sources, to determine whether the child’s disability was
directly related to the code of conduct violation.

Nature of behavior subject to disciplinary action:

__________________________________________________________________________________________
__________________________________________________________________________________________

Upon completion of the evaluation:

1. Did the 504 Team review relevant information in the student’s file? □ Yes □ No
Please specify:
__________________________________________________________________________________________
__________________________________________________________________________________________

2. Did the 504 school team review the student’s current 504 Plan? □ Yes □ No

3. Did the 504 school team consider information provided by parent/legal guardian? □ Yes □ No

3. Did the 504 school team determine that the conduct in question was caused by/or had a direct relationship to
the child’s disability? □ Yes □ No

*If yes, and student is not currently on a Section 504 plan, the school team should consider developing a
Section 504 plan to address the student’s current needs.

4. Was the child’s conduct a direct result of the district’s failure to implement the 504 Plan? □ Yes □ No

Based upon review of all relevant information and in consideration of the specifics of the code of conduct
violation, the 504 Team has determined that the behavior subject to disciplinary action:

□ Was □ Was Not a manifestation of the student’s disability.

Signature: ____________________________Signature: ______________________________

Signature: ____________________________Signature: ______________________________

Signature: ____________________________Signature: ______________________________

 COMPLAINT PROCEDURES

Complaint Filing Form

General Statement

The District strives to provide an environment free from discrimination. The District encourages
students, parents and staff to identify barriers to a discrimination-free and an appropriate learning
environment in the school(s). The purpose of the Complaint Filing Form is to address
complaints of disability discrimination under Section 504 and Title II. All complaints will be
received and investigated in a fair and expeditious manner. The District will take affirmative
steps to address and correct any substantiated finding of discrimination.

This policy does not deny the right of the complaining party to file formal complaints at any time
with the U.S. Department of Education, Office for Civil Rights or to seek private counsel for
complaints alleging discrimination.

Steps to Resolution

Step 1: Principal or Immediate Supervisor (Informal and optional--may be bypassed by

complaining party)

An informal meeting with the parties and the principal or the Compliance Officer can solve
many problems. An individual with a complaint is encouraged to first discuss it with the teacher,
counselor, or building administrator involved with the objective of resolving the matter promptly
and informally. Employees with a complaint are encouraged to first discuss it with their
principal or immediate supervisor with the same objective.

Step 2: Section 504 Compliance Officer

If the complaint or issue is not resolved at Step 1, or if the complainant does not wish to use the
informal procedures set forth in Step 1, the complaining party may file a written complaint
(FORM F) stating: 1) the nature of the complaint; and 2) the remedy requested. The complaining
party must sign and date the complaint. The written complaint must be filed with the building’s
Section 504 coordinator within thirty (30) days of the event or incident, or from the date the
complaining party could reasonably become aware of such occurrence.

Responsibility of the Section 504 Compliance Officer

The Section 504 Compliance Officer is appointed by the Board and is personally responsible for
Section 504 compliance throughout the District. The Section 504 Compliance Officer has the
authority to investigate all written grievances and to issue corrective actions to address non-
compliance with federal law. The Section 504 Compliance Officer will prepare a written report
of all investigations, which shall include the following:

• A clear statement of the allegations of the complaint and the remedy sought by the
grieving party.

• A statement of the facts as contended by each of the parties.

 • A statement of the facts as found by the Section 504 Compliance Officer and
identification of evidence to support each fact.

• A list of all witnesses interviewed and documents reviewed during the investigation.

• A narrative describing attempts to resolve the complaint.

• The Section 504 Compliance Officer’s determination as to whether the allegations in

the complaint are meritorious.

The Section 504 Compliance Officer will complete the investigation and issue a final decision
and report within forty-five (45) days after receipt of the written complaint. The District will
take appropriate corrective action to address any substantiated finding(s) of discrimination noted
in the final decision and report of the Section 504 Compliance Officer. The Section 504
Compliance Officer will send a copy of the final decision and report to the complaining party
within the forty-five (45) day period. If the Section 504 Compliance Officer believes the
complaint is valid, the final decision and report issued by the Section 504 Compliance Officer
will include recommendations for appropriate corrective actions to be taken by the District.

Other Options of the Complaining Party

At any time during this process, the complaining party may file a complaint with the U.S.
Department of Education, Office for Civil Rights.

28
FORM F
Section 504 Complaint Filing Form

Date _____/_____/_____
Child’s Name ______________________________ D.O.B. ______________________________

Address ___________________________________School _______________________________

Parent’s Name (print) ______________________________________________________________

Home Phone ___________________ Cell Phone _________________ Work _______________

Telephone Number ______________________ Email __________________________________

Nature of your complaint. (Please describe the policy or action you believe may be in violation
of Section 504. Please also identify any person(s) you believe may be responsible.)
________________________________________________________________________________
________________________________________________________________________________
________________________________________________________________________________

Please provide your proposed remedy to this alleged violation:

________________________________________________________________________________
________________________________________________________________________________
_________________________________________________________________________________
_________________________________________________________________________________

___________________________________________ _____/_____/______
Signature of Complaining Party Date

____________________________________________
Signature of Person Receiving Complaint

_____/_____/_____ ___________________________________________
Date Location

THIS FORM SHOULD BE FORWARDED WITHIN THIRTY (30) DAYS OF THE ALLEGED
VIOLATION OF THE PROCEDURAL SAFEGUARDS TO:

Section 504 Compliance Officer: Wayne J. Belock, Esq.

Section 504 Compliance Officer
Cleveland Metropolitan School District
1111 Superior Avenue East, Suite 1800
Cleveland, Ohio 44114
Phone: (216) 838-0070
E-mail: Wayne.Belock@clevelandmetroschools.org

29
 MEDIATIONS AND HEARING PROCEDURES

SECTION 504 MEDIATION AND HEARING PROCEDURES

Mediation procedures for Section 504 are not intended to delay or hinder the parent/legal
guardian’s right to a hearing. Rather, they are intended to assist the parent/legal guardian in
resolving differences and in obtaining a free appropriate public education for their child.

When the parent/legal guardian does not agree with the Section 504 evaluation findings and/or
the Section 504 Plan, the following may occur:

1. The school principal arranges a conference that includes the parent/legal guardian, the
classroom teacher(s), and/or participants as needed. The parent/legal guardian is
given a copy of the Section 504 Procedural Safeguards. If the parent/legal guardian is
non-English speaking, an interpreter is provided.

2. The school principal conducts the conference and an informal resolution of

differences is sought.

(a) The school principal explains to the parent/legal guardian that this process does
not interfere with his/her right to file a formal complaint.

(b) The school principal/designee summarizes the results of the

conference in writing, sends copies to the parent/legal guardian and places
copies in the student’s permanent educational file.

Due Process Procedures

The procedures for Section 504 due process hearings ensure that:

1. A parent/legal guardian or the school district may initiate a hearing on matters dealing
with identification, evaluation or the provision of a free appropriate public education.
2. The district may initiate a hearing to override a parent’s refusal or revocation of consent
for a Section 504 evaluation.
3. Parents will receive timely notice of the date and time of the hearing, which shall be
mutually convenient.
4. The hearing officer will be selected by the District
5. The hearing officer shall not be:

a. Employed by an agency involved with the care or education of the student subject to
the hearing.

b. A person having a professional or personal interest that would conflict with his/her
objectivity in a hearing.
 Due Process Hearing Rights and Procedures

The parties to a Section 504 Due Process Hearing have a right to:

1. Be accompanied and advised by an attorney or representative

2. Have the assistance of an interpreter (if the parent’s natural language is not English and
given adequate notice to the District)

3. Present evidence and examine witnesses

4. The hearing officer shall render a decision, subject to judicial review that is binding on all
parties, except that in all cases any action taken must comply with the current Ohio Revised
Code and federal court decisions.

5. The party initiating the due process hearing will bear the burden of proof.

6. Parents or the District may initiate a due process hearing on a matter related to (1) eligibility
and related procedures, (2) procedural safeguards, or (3) provision of a free and appropriate
public education to the student.

7. Requests for a due process hearing must be submitted in writing to the Chief Executive
Officer (or designee).

8. The request shall include:

• The name of the student

• The name of the parent or legal guardian
• The address and telephone number of the legal guardian
• The name of the school the child attends
• A statement of the issues to be presented at the hearing.
• A statement of the remedy requested of the hearing officer.

Decision of the Hearing Officer

The hearing officer shall review all relevant facts and render a decision.

A copy of the hearing officer’s decision shall be delivered to the District and the parent/legal
guardian within forty-five (45) days from the date of the hearing.

Notification will include a statement that either party may appeal the decision to a district court
of competent jurisdiction.
FORM G

AUTHORIZATION TO ____________________________________
RELEASE/SHARE CONFIDENTIAL ____________________________________
INFORMATION ____________________________________
____________________________________
I, (Name of Parent) ____________________________________
____________________________________
____________________________________
___ hereby authorize (Name of School I understand that information provided
between the above-named parties will be
District)
used solely for the purpose of making
____________________________________ educational decisions on behalf of my child.
I further understand that I can revoke this
___ and (Name of Provider)
authorization at any time by providing a
____________________________________ written request to (title)
_________________________, (name)
__ to release and share educational
_______________________________ at
records/information related to my child (address and phone
number)_____________________________
___________________________, (D.O.B.)
_________________. Otherwise, this
_______________. authorization is valid for 180 days from the
date of my signature below.

This Authorization permits the sharing of I understand that I have a right to receive a
copy of this Authorization, and that any
personally identifiable information between
modification or revocation of this
the above-named parties. The records Authorization must be in writing.
authorized to be disclosed include:
Signature:
Attendance records ____________________________________
Standardized/group testing ___ Date: _________________
Classroom observations
Evaluation Team Reports (ETRs) Relationship to Child:
Classroom testing & work samples _____________________________
Individualized Education
Programs (IEPs)
cc: Student permanent education file
Course history reports
Parent/Guardian
Expulsion notices
Grade reports/Transcripts
Office referrals
Interim progress reports
Suspension notices
Section 504 plans
School health records
Other necessary information below
Immunizations records