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Forms & Processes

These forms and resources have been developed to assist parents and educators in determining eligibility for 504 services and addressing 504 requirements.

Heartland AEA Documents

Guide to Section 504 (PDF)

Informative brochure which is often used by districts to notify parents of their rights under Section 504 and serve as second notice
Section 504 Checklist (PDF) A step-by-step guide through the 504 process of identification to eligibility determination to plan revision
Parental Consent Form (PDF) Form to obtain parental consent prior to evaluation for 504 eligibility and notice of parental rights
Medical Release Form (Word Doc) Iowa Department of Education release form modified with their consent to serve for Section 504; district letterhead may be placed at the top of the forms
Eligibility Form (PDF) Helpful resource for determining eligibility for 504 services
Manifestation Determination Guide (PDF) An optional form that districts may use if they don't have their own

504 Plan Template (PDF)

*504 Plan without demographic information (PDF)

A blank 504 plan template which districts may use to write student plans

*Extra page to add to 504 plan template without demographic information at the top

Teacher Input Form (Word Doc) Allows teachers to give meeting input without attending

Student Accommodation Request (SAR) Form (Word Doc)

*Directions for completing SAR form (Word Doc)

Required form for graduating students with 504 plans attending post-secondary education

State Documents

DE Special Education Withdrawal Letter (PDF) Iowa Department of Education guidance for parents who withdraw children from special education and demand Section 504 plans
Diet Modification Request Form (PDF) Iowa Department of Education form to assist districts/schools in noting substitutions in meals for students who are considered to have a disability as defined by Section 504 or the Americans with Disability Act


For additional information on Section 504 requirements in Iowa, visit:

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