504 Form (Medical Accommodation)

504 Form
Medical Accommodation Request Form

Students may have a medical diagnosis that warrants a 504 plan. If your child has previously had a 504 plan, please make sure to send in updated paperwork at the beginning of the school year. If you think your child may need a 504 plan, please fill in the paperwork here and contact Ms. Ciarniello: 718-648-4016 ext 1383 or email msciarniello@queenscollegiate.org

Click on the PDF icon to download the 504 form.

Or read and download the 504 form at this link: https://drive.google.com/file/d/1i7hnKbHk7Lxv84rrvOeXETrsp-r6WZh-/view?usp=sharing. This link opens in a new window.

Advanced Placement (AP) courses and College Now

QUEENS COLLEGIATE
MIDDLE AND HIGH SCHOOL

504 Form
Medical Accommodation Request Form

Click on the PDF icon to download the 504 form.

Or read and download the 504 form at this link: https://drive.google.com/file/d/1i7hnKbHk7Lxv84rrvOeXETrsp-r6WZh-/view?usp=sharing. This link opens in a new window.

167-01 Gothic Drive
Jamaica, NY 11432
Phone: (718) 658-4016
Fax: (718) 658-5149
District 28

Created by Ms. L. Dalphond
updated March 13, 2024 by Ms. Dalphond

QUEENS COLLEGIATE
MIDDLE AND HIGH SCHOOL

Department of Education

Advanced Placement (AP) courses and College Now

QUEENS COLLEGIATE MIDDLE AND HIGH SCHOOL

504 Form Medical Accommodation Request Form

Click on the PDF icon to download the 504 form. Or read and download the 504 form at this link: https://drive.google.com/file/d/1i7hnKbHk7Lxv84rrvOeXETrsp-r6WZh-/view?usp=sharing. This link opens in a new window.

QUEENS COLLEGIATE
MIDDLE AND HIGH SCHOOL

504 Form
Medical Accommodation Request Form

Click on the PDF icon to download the 504 form.

Or read and download the 504 form at this link: https://drive.google.com/file/d/1i7hnKbHk7Lxv84rrvOeXETrsp-r6WZh-/view?usp=sharing. This link opens in a new window.