504 Plan Update Form
Child's name as it appears in PowerSchool
*
First Name
Middle Name
Last Name
Idaho State Student ID (EDUID)
*
PowerSchool Student ID
*
Grade Level
*
504 Plan Date
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Student Qualifies for:
*
504 Plan
504 Protection
504 Plan Termination Date
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
504 Plan Termination Reason
Please Select
Graduate
Revoked Consent
No Longer Eligible for 504 Plan or Protection
Moved Out of District
Service School ID
*
Please Select
Early Childhood Center - 1416
Cottonwood 1437
Farnsworth Middle 1446
Harwood Elementary 0723
Jefferson Elementary 0725
Jefferson High 1143
Midway Elementary 0724
Rigby High 0114
Rigby Middle 1358
Roberts Elementary 0726
South Fork Elementary 1110
Case Manager
*
In District Transfer
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Receiving School
Please Select
Cottonwood Elementary
Harwood Elementary
Jefferson Elementary
Midway Elementary
Roberts Elementary
South Fork Elementary
Farnsworth Middle School
Rigby Middle School
Jefferson High School
Rigby High School
Please verify that you are human
*
Submit
Should be Empty: