1 Start 2 Complete Welcome to the Student Case Submission Form for ECHO Idaho's K12 Education: Section 504 series.Case Study Discussion GuidelinesAs part of our training, we will be engaging in discussions about student case studies. This is a wonderful opportunity to learn from each other, share experiences, and explore solutions collaboratively. Please provide your contact information. We will not share this information Presenter First and Last Name * Student Information PrivacyPlease do not include any identifiable student information such as: Personally identifiable Information (PII), or Protected Health Information (PHI) or information protected by the Family Educational Rights and Privacy Act (FERPA). If you have any questions regarding this form, please contact [email protected] Student Information Privacy Acknowledgement * Click here to acknowledge. Student Information Student Grade Level PreK K-2 3-5 6-8 9-12 18-21 Program Please list any relevant, non-identifiable background information about the student (e.g., medical/psychological diagnoses, current medications, family/social history, etc.). What disability category qualifies this student for a 504? Specific learning disability Speech or language impairment Other health impairment (ADHD) Autism Intellectual disability Emotional disturbance Developmental delay Hearing impairment Orthopedic impairment Visual impairment Traumatic brain injury Hearing or vision impairment Other... What disability category qualifies this student for a 504? Other... What barriers to accessing the general education curriculum is this student currently experiencing? Is this student currently on a 504 Plan? Yes No List any relevant and non-identifiable accommodations that are stipulated on the student's 504 plan. Discuss any (additional) accommodations that need to be provided for this student (e.g. class schedules, testing formats, providing assistive technology, or allowing for breaks). Please describe any organizational policies or processes that may make it difficult to implement accommodations for this student. What hopes or expectations do teachers have regarding this student's education? What hopes or expectations does the student and/or student's family have regarding this student's education? What questions can be posed to ECHO participants regarding this case? FERPA & HIPAAOur discussions must also strictly comply with the Family Educational Rights and Privacy Act (FERPA) and the Health Insurance Portability and Accountability Act (HIPAA). FERPA is a federal law that protects the privacy of student education records. This means that any academic information, such as grades or educational services received, should not be shared without explicit consent from the student or the student's parents if the student is a minor. Meanwhile, HIPAA safeguards patient health information. Under HIPAA rules, it is prohibited to disclose health information that could identify a patient. This includes medical histories, treatment records, or any other health-related information. Discussion Etiquette1. Please use broad terms when discussing a student’s academic performance or health information. 2. Consider using fictitious names or simply refer to the student as "the student." 3. Share information only as relevant to the professional development of the group, always keeping the student's privacy at the forefront. Our goal here is to learn and grow as professionals, not to investigate personal details of our students' lives. Their trust in our services hinges on our commitment to confidentiality and respect for their private information. Thank you for your commitment to upholding these crucial standards.Thank you for completing ECHO Idaho's K12 Section 504 Student Case Submission Form. Leave this field blank
