Download: Sample 504 plan for a child with ADHD

Looking for a sample 504 plan for a child with ADHD 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 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 involve parents. You can use this sample 504 plan form 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.

While this sample 504 plan is for a child with ADHD, it can be adapted for other disabilities. You can fill in and adjust the blank sample 504 plan as needed.

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.