504--20

Oct 2014

Alamance-Burlington School System

1712 Vaughn Road, Burlington, North Carolina 27217

336.438-4141 Fax 336.570.6078

abss.k12.nc.us

Vernetta Bridges
Director for Student Services / William Harrison, Ed. D.
Interim Superintendent

Student ______Date ______School______

Dear Parent/Guardian:

You are receiving this letter because:

You wrote on the Health and PE form that your child ______

__ You sent medical documentation giving permission for your child to take medication at school

¾  _Your child has an Emergency Medical Plan

¾  _Your child has an Individual Health Care Plan

¾  _Other

Section 504 of the Rehabilitation Act of 1973 and the Americans with Disabilities Act prohibit discrimination against any individual on the basis of disability. It is the responsibility of ABSS to seek out disabled students and determine whether or not they have the same access to education as their non-disabled peers

.

A disability according to these laws means a physical or mental impairment that substantially limits one or more major life activities such as seeing, hearing, breathing, walking, learning, communicating or the operation of a major bodily function such as neurological, digestive, and respiratory.

If identified as disabled, your child will receive “Rights and Protections”. If the disability is denying your child an equal access to education, your child might receive educational supports through a 504 Plan.

Please indicate the action you want the school to take on behalf of your child by initialing the statement that applies and signing below.

____I want my child evaluated for Section 504 eligibility

____At this time I do not want my child evaluated for Section 504 eligibility

______

(Parent/Guardian Signature) (Date)

Please return this form and direct any questions to:

______at ______

(Print name and title) (phone)

Sincerely,______

In compliance with federal laws, the Alamance-Burlington School System administers all educational programs, employment activities and admissions without discrimination because of race, religion, national or ethnic origin, color, age, military service, disability, or gender, except where exemption is appropriate and allowed by law. Inquiries or complaints should be directed to Dr. Todd Thorpe, Assistant Superintendent for Student Services, Alamance-Burlington School System, 1712 Vaughn Road, Burlington, NC 27217, (336) 438-4150.

Original to Parent: Copy in student’s 504 Folder