Authorization for Section 504 Evaluation

In order for Montgomery County Public Schools (MCPS) to evaluate the student’s eligibility under Section 504 of the Rehabilitation Act of 1973, I give permission to the school psychologist to conduct assessment activities. I give permission to the school community health nurse or school health room technician to contact any medical personnel and to share such information with the school psychologist (when necessary). I understand that in carrying out assessment activities the school psychologist will review the student’s records; will observe the
student; may interview the student, the student’s teacher, or myself; and/or may conduct additional functional or normative assessment activities, as necessary. I understand further that the results of the assessments will be included in a confidential student file that MCPS staff members may access on a need-to-know basis and that I may authorize release of the information to another agency or professional.

Authorization for Section 504 Evaluation	48 K	English
Autorización para la Evaluación de la Sección 504	80 K	Spanish
Autorisation d'évaluation en vertu de la section 504	50 K	French
Authorization for Section 504 Evaluation - Cho Phép Thẩm định Section 504	150 K	Vietnamese
504條款計畫評估授權	87 K	Chinese
504 조항 평가 동의서/Authorization for Section 504 Evaluation	75 K	Korean
ለትምህርት ቤት የስነ-ልቦና ባለሙያዎች ፈቃድ (ሥልጣን ስለመስጠት) ክፍል (Section) 504 የትኩረታዊ የጤና እክሎች ግምገማ (Attentional Disorders Assessment)	73 K	Amharic
Autorização para Avaliação da Seção 504	50 K	Portuguese

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