School Accommodation/Support Letter (IEP/504)

Practice Name/Address/Phone: [Practice contact information]

Clinician Name, Credentials, License #: [Name, degree(s), license number]

Date: [Date]

To: [School Team/504 Coordinator/IEP Team, School Name, District]

Re: [Student Name], DOB: [Date of birth]

Confidentiality Notice: Contains confidential health information; intended for school planning for [Student].

Authorization & Purpose

[Shared with school with signed authorization on file dated [date] / Provided to parent/guardian for delivery to school]

This letter summarizes school-relevant functional impacts and offers recommendations for school evaluation and supports; the school team determines eligibility, services, and the final plan.

Clinical Context

(Provide only information necessary for school planning. Avoid detailed medical history or sensitive family information. If key information is unknown, state "Information not available.")

• Relevant diagnosis(es) and status: [Condition(s) with status: confirmed vs. suspected; date established or most recent update]
• Current treatments with school relevance: [Medications influencing alertness, appetite, behavior, or safety; activity restrictions; medical devices or supplies needed at school]
• Expected duration: [Temporary with timeframe / Chronic or long-term / Episodic / Unknown]
• Triggers or patterns: [Known triggers, flare patterns, or times of day when symptoms predictably affect school participation] (If none known, omit this item.)

Functional Impact Profile

(This is the core section. Describe observable effects on school functioning using concise, concrete language. Include frequency or severity when known. Attribute source as appropriate: "Per parent report," "Per teacher report," "Observed in clinic," "Per outside evaluation dated [date]." Address only domains that apply to this student.)

Relevant domains may include: attendance and stamina; learning, attention, and executive function; communication and language; motor, sensory, and access needs; behavioral and social-emotional functioning; health and safety at school.

[Functional impact descriptions organized by relevant domain, with qualified sourcing and frequency/severity as known]

Recommendations

(Include only recommendations directly tied to the functional impacts above. Use "consider" phrasing. The school team determines eligibility, services, and placement.)

• School evaluations to consider: [Relevant evaluations such as 504/IEP eligibility, psychoeducational, speech-language, OT/PT, FBA, assistive technology, or school nursing assessment] (Include only those tied to identified functional needs.)
• Classroom and testing accommodations: [Instructional supports, workload/pacing modifications, environmental adjustments, attendance flexibility, testing accommodations, PE/activity modifications as applicable]
• Related services and supports: [School counseling, check-in systems, behavior support, therapy services, case management as applicable] (Include only if clearly linked to functional needs.)
• Health and safety planning: [Medication access, emergency response steps, staff training needs, field trip considerations as applicable] (If a condition-specific action plan is attached, note: "See attached [plan name] dated [date].")

Clinician Statement

These recommendations are based on clinical assessment and available history and are intended to support the school team's evaluation and planning. I do not determine IEP/504 eligibility, services, or educational placement. Recommendations are effective for [current school year / next 12 months / until: [date]], and reevaluation is warranted if symptoms, treatment, or academic status change significantly. For school follow-up, contact [preferred contact method].

Signature

[Signature]

[Clinician Name, Credentials, License #]

[Practice Contact Information]