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    Determining 504 Eligibility-Students with ADD


    Teacher Name: Mr. Ougel


    Student Name:     ________________________________________

CATEGORY
4
3
2
1
Classroom Performance
Student is not performing successfully in all subject areas and teachers indicate that academic difficulties are attributed to ADD.
Student is not successful in most classes and teacher observation suggest that academic difficulties could be due to ADD.
Student is successful in most classes and academic difficulties are not attributed to ADD.
Student is successful in all classes.
Physician's Statement
Child is unable to learn even with medications and accomodations are necessary.
Child's learning is minimal even with medications and accomodations would benefit.
Child's condition can be controlled by medications and accomodations may be used.
Child's condition is mild and not on medication. Accomodations are not necessary.
Standardized Test
Scores reflect no yearly gains.
Scores reflect minimal learning gains in less than 2 subtest areas.
Scores reflect minimal to average learning gains in all subtest areas.
Learning gains are average to above average in all subtest areas.


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