top of page

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

Click on the PDF icon to download the 504 form.

Or read and download the 504 form at this link: This link opens in a new window.

bottom of page