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Authorization for School Psychologists Section 504 Attentional Disorders Assessment

About this Form

Form number: 270-2a

Audience:  Parents/Guardians, School Staff

Last revised: November 2016

Related Forms

Form 270-2 - Section 504 Plan

Form 270-2b - Section 504 Evaluation

Form 270-2c - Section 504 Progress and Accommodation Review Worksheet

Form 270-2D - Distribution of Section 504 Plan

Form 270-2E - Section 504 Causation Meeting Form

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.

Adobe PDF Authorization for School Psychologists Section 504 Attentional Disorders Assessment43 KEnglish
Adobe PDF Autorización a Psicólogos Escolares para Realizar la Evaluación de Sección 504 de Trastornos de Atención74 KSpanish
Adobe PDF Authorisation pour une Évaluation de Troubles Attentionnels pour le Plan Section 504 par le Psychologue de l’École33 KFrench
Adobe PDF Đơn Cho Phép Nhà Tâm Lý Trường Học Thẩm Định Chứng Rối Loạn Tập Trung Theo Điều Khoản 50499 KVietnamese
Adobe PDF 學校心理專家504條款注意力失調評估授權157 KChinese
Adobe PDF 학교 심리학자 504 섹션 집중 장애 평가시험 허가서57 KKorean
Adobe PDF ለትምህርት ቤት የስነ-ልቦና ባለሙያዎች ፈቃድ (ሥልጣን ስለመስጠት) ክፍል (Section) 504 የትኩረታዊ የጤና እክሎች ግምገማ (Attentional Disorders Assessment)53 KAmharic

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