504 Request Letter Builder
Choose the areas you want named and write what you have seen at home. The builder arranges your own words into a dated letter asking your district to evaluate your child for a 504 plan, ready to copy, print or edit.
How to use it
- Fill in the four steps. Your child's first name and grade, the areas you want named, what you have observed and how you would like the school to reply.
- Read the letter as it builds. Every line comes from your own entries. Nothing is interpreted, diagnosed or rewritten on the way in.
- Copy or print it, then read it once more. It is a starting point in your own words. Edit any line before you send it.
Private by design. The builder itself sends nothing. Your letter is assembled in your browser and this page keeps no record of it. The only thing that ever leaves this page is an email address you choose to type into the free-printable form below.
Your request letter
Every line below comes from your own entries. Read it through and edit anything above that you want worded differently.
[today's date]
504 Coordinator or Principal
School or District
Re: Request for a 504 plan evaluation for [student first name], [grade]
Dear 504 Coordinator or Principal,
I am the parent or guardian of [student first name], who is in [grade]. I am writing to request an evaluation for a 504 plan. Please treat this letter as my written request and place a copy in [student first name]'s educational record.
The areas I am bringing to the school's attention are [areas the parent selects].
My observations are:
[the parent's observations]
I am sharing these observations so the school can consider my request through its evaluation process. Please let me know where to send any records I choose to provide and identify the staff member who will coordinate the response.
Please confirm receipt and share the next procedural steps.
Thank you for reviewing my request.
Sincerely,
[parent or guardian name]
Parent or guardian of [student first name]
This builder is educational information, not legal or educational advice. It does not come from a school district or a government agency. It arranges your own words into a letter. It does not decide whether a child is eligible, it does not diagnose a child and it does not choose accommodations. The letter is your own statement, a starting point to read and edit before you send it. Section 504 rules are cited where they apply. Your state and your district add their own procedures, so confirm anything you plan to rely on with your district or your state's parent training and information center.
Records some parents send with it
Anything you attach is yours to choose. Label each item and keep the same set with your own copy.
- Relevant schoolwork samples
- Report cards or progress reports
- Attendance records
- Messages with school staff
- Records you choose to provide
- A short home observation log
Nothing on this list is required. It is an organizer for the records you already have, not a checklist the school is waiting on.
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.
Instant download, plus a note if the guidance on this topic changes. Unsubscribe anytime.
What this builder does
It turns the areas you tick and the observations you write into one dated letter asking your district to evaluate your child for a 504 plan. The letter is your statement in your words. The builder adds the structure a written request usually carries: a date, the child and grade, the request itself, the areas you are raising, your observations and a line asking the school to confirm receipt.
What it never does is speak for you. It does not diagnose, it does not say a child is eligible and it does not name an accommodation. Those are decisions a group of people who know your child makes from an evaluation, not decisions a letter makes.
How the letter is organized
- A date, so there is a clear record of when the request was made.
- An opening that identifies your child and states the request.
- The middle, which carries the areas you selected and the observations you wrote.
- A closing that asks the school to confirm receipt and reply the way you prefer.
- Your signature, once you have read the whole thing and made it sound like you.
The free 504 Plan Request Letter Template is the same letter as a printable to fill in by hand. The guide on how to request a 504 plan covers what happens after it arrives.
What the school does with it
Section 504 puts the evaluation and placement steps on the district (34 CFR 104.35) and gives parents a set of procedural safeguards around those decisions, including notice and a way to challenge them (34 CFR 104.36). The eligibility question itself is whether a physical or mental impairment substantially limits one or more major life activities (34 CFR 104.3(j)), which is why the letter describes what you see rather than arguing a conclusion. The guide on what qualifies for a 504 plan works through that test in plain language.
This builder writes your letter. The free 504 Plan Request Letter Template is the printable version. A one-page PDF to fill in by hand or file in the binder beside the copy you send. It stays free.
