The 504 Plan Request Letter Template (Free Printable)
A free printable read against IDEA and Section 504, written to help you walk in prepared.
Last reviewed . Read against Section 504, 34 CFR 104.35.
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What is the 504 Plan Request Letter Template?
A 504 plan request letter is a short, dated letter to your school's Section 504 coordinator asking the district to evaluate your child for a 504 plan. Section 504 requires a district to evaluate a student who, because of disability, needs or is believed to need special education or related services before it takes any action on placing that student in regular or special education (34 CFR 104.35(a)). A written request is the clearest way to start that conversation while keeping a record of when you asked. The regulations set no federal deadline in days and no national form, so this template asks for a written response by a date you name and for a copy of the district's own Section 504 procedures.
How to use this printable. This is a starting template to help you put a request in writing. It is general educational information rather than legal advice. It is not a form the school is required to accept. Read it over and adapt every bracketed part to your own child before you send it. Section 504 forms, timeframes and procedures are set locally, so ask your district how its own process works.
How to use it
Fill in the bracketed parts in your own words: your child's name and grade, the diagnosed or suspected condition, what you actually see it limit at school and what you are asking for. The strongest version of this letter is specific about the second part, since Section 504 eligibility turns on how a condition limits a major life activity rather than on the diagnosis label alone. Send it to the person your district names as its Section 504 coordinator, keep a dated copy and note the day you sent it.
What is on the printable
Fields in brackets are yours to fill in. Read the letter over and adjust it to your child's situation before you send it.
Subject: Request for a Section 504 Evaluation for [Child's Full Name]
Dear [504 Coordinator or Principal Name],
I am writing to request an evaluation for my child, [Child's Full Name], date of birth [Date of Birth], currently in [Grade] at [School Name], to determine whether they are eligible for a plan under Section 504 of the Rehabilitation Act of 1973.
[Child's First Name] has [name the diagnosed condition, or write: a suspected condition we are in the process of having assessed]. [If you have documentation, add: I have attached (or can provide) (a letter from our doctor, an outside evaluation, a pattern in report cards) that supports this.]
Here is what I see it limit at school: [describe two or three specific examples in your own words, for example: cannot stay with a reading task long enough to finish a passage the class reads in one sitting; misses instruction on the days symptoms flare; needs to stop partway up the stairs to the third-floor classroom]. In everyday terms these affect [name the major life activities involved, for example: reading, concentrating, learning, walking, breathing or caring for oneself].
I am asking the district to evaluate [Child's First Name] and to have a group of people who know them, who understand the evaluation information and who know the accommodation options decide together whether a Section 504 plan is appropriate and what it should include.
I would appreciate a written response confirming you received this request and telling me what the district's next steps and timeframe are. [If you want to propose a date, add: I would appreciate hearing back by (date), about (two or three) weeks from today.] If it would help to talk it through first, I am glad to meet.
Please also send me a copy of the district's Section 504 procedures and the notice of parent rights under Section 504. If the district decides not to evaluate [Child's First Name], I would appreciate that decision in writing with the reasons for it.
You can reach me at [phone number] or [email address]. I am keeping a copy of this letter for my records.
Thank you for your time and for helping me understand the next step.
Sincerely,
[Your Name]
Parent or guardian of [Child's Full Name]
[Your Address]
[Phone Number] / [Email Address]
[Date]
Why this letter says what it says
| Section 504 calls for an evaluation before a district places a student who needs or is believed to need special education or related services. 34 CFR 104.35(a) | The rule reaches a student who, because of disability, needs or is believed to need special education or related services. It applies before any action on the initial placement in regular or special education as well as before any later significant change in placement. A reasonable belief that your child may need support is enough to put the question in front of the district, which is exactly what this letter does. |
|---|---|
| The decision is made by a group of people rather than one person, drawing on more than one source of information. 34 CFR 104.35(c) | Placement decisions have to draw on information from a variety of sources such as aptitude and achievement tests, teacher recommendations, physical condition, social or cultural background and adaptive behavior. All of that information must be documented and carefully considered. The group deciding includes people who know your child, who understand the meaning of the evaluation data and who know the placement options. That is why this letter describes what you see rather than only naming a diagnosis. |
| Eligibility turns on an impairment that substantially limits a major life activity, not on the diagnosis label. 34 CFR 104.3(j) | Section 504 covers a student with a physical or mental impairment that substantially limits one or more major life activities, such as learning, reading, concentrating, walking, breathing or caring for oneself. Since the ADA Amendments Act of 2008 that definition is construed broadly. The help most mitigating measures provide, such as medication, is set aside when deciding whether a condition substantially limits an activity. That is the reason the letter names the activity affected alongside the condition. |
| You have a right to notice, to see your child's records and to challenge a decision you disagree with. 34 CFR 104.36 | Districts have to establish and implement a system of procedural safeguards covering identification, evaluation and educational placement. Those safeguards include notice, an opportunity to examine relevant records, an impartial hearing in which you can take part and be represented by counsel as well as a review procedure. Asking for a copy of those procedures at the start means you know the route before you ever need it. |
| Section 504 sets no federal deadline in days and no national form. 34 CFR 104.35 and 104.36 | Neither section names a day count for completing an evaluation. Neither prescribes a form or a plan template, which is why districts use their own paperwork and their own timeframes. Some states and districts set a timeline of their own. Ask yours what it follows. Proposing a date in the letter gives the request a marker without assuming a deadline. |
| An IDEA evaluation request is a separate request under a different law. 34 CFR 300.301 | If you think your child may need specially designed instruction rather than accommodations alone, a request for an initial special education evaluation under IDEA is the other route. That one does carry a federal 60-day timeline running from your written consent. Some families ask about both at once. The evaluation-request letter on this site covers the IDEA version. |
Sending tips
- Send it to the person the district names as its Section 504 coordinator and copy the principal, so the request does not sit in one inbox while someone is out
- Send it in a way that leaves a dated record: email, certified mail with return receipt, or hand delivery with a signed and dated copy for your own file
- Keep a copy dated the day you send it and note who you sent it to
- Offer or attach any documentation you already have, such as an outside evaluation, a letter from a doctor or a pattern in report cards, rather than waiting to be asked for it
- No format is required for the request itself, so a clear dated letter in your own words does the job. Your district may also have its own referral form, which you can ask for and fill in alongside this letter
- If you have not heard back within the timeframe you named, follow up in writing and reference the date of your first letter
Get the free 504 Plan Request Letter Template (PDF)
A ready-to-adapt letter asking your district to evaluate your child for a 504 plan, with the parts that matter spelled out.
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