504 Accommodation Requests

If your child requires 504 Accommodations, please download and complete the forms below:

Note: ALL FORMS MUST BE FOR THE SCHOOL YEAR 2022-2023. Forms for 2021-2022 or prior years are not valid.

From Family: Fill out the request-for-section-504-accommodations-parent-form-with-hipaa-authorization-school-year-2022-2023.pdf

From Doctor: Have your child's health care provider fill out the medical-accommodations-request-form- school-year-2022-2023.pdf

Note that the former "Medical Review for 504 Accommodations" form is no longer needed

Please return both completed forms to Tessa Derfner, Assistant Principal, at TDerfner@schools.nyc.gov or to your child’s Guidance Counselor.

Requests for 504 Accommodations are reviewed by the NEST+m 504 Team monthly.

For more information on 504 Accommodations, and to find translated versions of these forms, please visit the Department of Education's 504 Accommodations webpage. Also see the Student & Family Guide.

Tessa Derfner
Assistant Principal
K-12 Special Education
TDerfner@schools.nyc.gov