Download: Sample 504 plan for a child with ADHD

This printable 504 template can help you work with the school to create a 504 plan. The download includes a blank template and a completed sample to help you get started.

Sample 504 planPDF - 233.2 KB

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Looking for a sample for a child with or another challenge? It might be hard to find one. That’s because while IEPs are based on a federal model, Section 504 of the Rehabilitation Act doesn’t provide a standard form or template for 504 plans.

Each school district develops its own 504 plans. In fact, the law doesn’t even require that the plan be written or have parent input. Most school districts, however, will use written 504 plans and will involve parents.

How to use the template

The first page of the download is a blank 504 plan template. Use it to take notes at a meeting or bring in your own thoughts. You might even suggest that the school use this form if they don’t already have a standard form. Don’t be surprised, however, if the school decides not to use this form.

The second page is a completed sample 504 plan for a child with ADHD. You can use it as an example to get started. The plan can be adapted for other disabilities.

Keep in mind that a 504 plan is for services and supports in the general education classroom. If a student needs specialized instruction, it may be time to talk to the school about an IEP instead of a 504 plan.

Learn more about the difference between IEPs and 504 plans.


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