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504StudentAccommodationPlan

DateWritten:

Student:Sara
ParentName(s):MomandDad

District:ABCDistrict
PlanFacilitator:

Reviewed:

Grade:9th
DateofBirth:2/1/00

AreasofStrength:

StraightAstudentandplanstoattendmedicalschoolsomeday

DescribeAreasofConcernBasedonEligibilityDetermination:

Mobility
Transportation

DateofEligibilityDetermination:TeamMembers:
Parent:Mom
Administrator:StephanieCooper
AreasofDifficulty

Mobility
AreasofDifficulty

Teacher:AnnaUpah
ExpertReviewer:
Accommodations

Additionalpassingtimewhenneeded,wheelchairavailable

Accommodations
Bustransportationwillbeavailableforstudent

Transportation

SchoolNurse:AshleyCampbell
Other:
PersonResponsible

ProgressMonitored/
DateofReview

Nurse

PersonResponsible
Bussingdepartmentr

ProgressMonitored/
DateofReview

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