Here is an example of a 504 plan.
College 504 Plan Template and Potential Items
(adapted from public school 504 template created by Judith
Leventhal, PhD, Leo Shea III, PhD, Janis Arnold, LICSW, Sharon
Farkas, Beth Sher, and Jennifer Jaff, Esq.)
Section 504 Plan for : ___(Student Name)____
Academic Year/Term ___________________________
Nature of the Disability
This student has a form of Inflammatory Bowel Disease (“IBD”) called
________________ (Crohn’s Disease or Ulcerative Colitis). IBD is a
chronic disease affecting the intestines. Ulcerative Colitis affects the
colon; Crohn’s Disease can affect any part of the digestive track, from
the mouth to the anus. It impacts the major life activity of disposing
of bodily waste.
Although its cause is unknown, IBD involves the immune system and
causes inflammation and ulceration of the lining of the intestines. The
emotional and physical pieces are interrelated in complex ways, and
patients can experience flare-ups during times of emotional tension
and stress. Changes in cognitive function from chronic or acute pain,
or side effects of strong medications, can include compromised
attention and concentration, reduced capacity to process information,
disruptions in memory and reduced ability to multitask are also
manifestations of this disease. Changes in physiological functioning of
the gastrointestinal tract characteristic of this disease can be
exacerbated during period of environmental and/or psychological
stress. The stress in/and of itself does not cause the disease.
Treatments can include immuno-suppressant drugs that render
patients more susceptible to illness and intensify reductions in
neurocognitive functioning described above. Patients may be on a
restricted diet; may need to eat several small meals per day; and
most likely will need to take medication during the course of the day.
Some treatments are provided intravenously in the outpatient
hospital setting that may cause a student to miss certain courses at
Although surgery is avoided to the extent possible, students affected
by IBD may require surgical intervention, including surgical revisions,
resections ore removal of portions of the digestive track.
Students with surgical resections of the intestines may suffer from the lack of a normal length of intestine, especially when part of the
small intestine has been removed. These students may suffer
particularly altered bowel demands, again necessitating easy access
to the bathroom.
Often, students with IBD work extremely hard to compensate for
their illness and its effects on daily functioning. Students with active
IBD will need to use the bathroom several times a day, often on a
moment’s notice, in order to avoid fecal incontinence. Incontinence
still may occur, and students who are impacted by this symptom will
need to be able to clean themselves and change clothes during the
IBD is a chronic illness that is cyclical; patients can face associated
gastrointestinal symptoms in a recurrent pattern, with periods of
symptom inactivity in between active flare-ups and complications.
Symptoms may worsen in an unpredictable manner and conversely,
may go into remission for varying lengths of time. Medications can
help manage the discomfort and inflammation and improve
functioning, but are not cures for IBD.
Introduction to the Plan
This is a Plan developed under Section 504 of the Rehabilitation Act of
1973 (“Section 504”), the Americans with Disabilities Act (“ADA”),
and the Individuals with Disabilities Education Act (“IDEA”) to identify
the health care-related needs of the student, as well as services and
accommodations to be provided to the student.
________________________ shall be the point person at the
university for purposes of carrying out the provisions of this Plan. This
person shall be known as the Plan Coordinator. The Plan Coordinator
will educate him/herself about the nature of IBD, the treatments the
student is receiving, the side-effects of the treatments, and the
student’s particular symptoms and needs. In addition, the Plan
Coordinator shall be responsible for ensuring that the provisions of
this Plan are carried out and he/she shall be the liaison between the
student, and the relevant university personnel.
For purposes of this Plan, __________ (the student) is a person with
a disability under Section 504 and the ADA. He/she is significantly
impaired in performance of the major life activity of disposing of
The purpose of this Plan is to maintain the student’s optimal
participation in his/her academic curriculum and educational goals,
aid in the management of his/her illness, and reduce the student’s
The Plan Coordinator and Due Process Rights
The Plan Coordinator will help make available a copy of this Plan, with
the student’s permission, to any relevant professors, teaching
If the Plan Coordinator is unable to obtain compliance with this Plan
by any professor other university personnel, he or she shall notify the Dean of Students. The Dean shall respond to each such
communication from the Plan Coordinator within two (2) in-session
school days with a plan for reconciling the interference with the
student’s educational mandates.
If the Dean declines to adopt any element or portion of the
recommended action plan, he or she shall put his or her reasons in
writing within two (2) in-session school days of receipt of the
recommended action plan, and this writing shall be sent to the
student and Dean.
Both the student and Plan Coordinator shall have the authority to
request a due process hearing if the Dean declines to accept the Plan
Coordinator’s action plan. This hearing shall be in addition to, not
instead of, any due process rights the student has under the ADA,
Section 504, and/or
The Student’s Symptoms and Needs
________________________ (the student) has the following
symptoms and needs, which may change over time:
_____ Diarrhea (estimated ___ bathroom trips per day)
_____ Pain and cramping (rated a ___ out of 10, with 10 being the
_____ Vomiting (estimated ___ times per day)
_____ Student has had surgery (___ times)
_____ Student has an ostomy or other surgical revision of the
_____ Student takes medication during the day
List medications and dosages here:
_____ Student has dietary restrictions
_____ Student receives treatments/office visits that require absences
Estimated Frequency: every ____ weeks
Expected duration of absence: ___ days per treatment
Student requires university personnel assistance with:
___ dietary needs
___ ostomy or other pouch emptying and cleaning
___ Other (specify):
Side effects of student’s particular medications may cause/impact:
___ Difficulty focusing, concentrating, sustaining attention
____Hand/Limb tingling or tremors
___ Other (specify):
Potential Accommodations (select as necessary/relevant)
1. The student will be permitted free access to leave courses for
use of the restroom, without asking permission, and without
2. If a student bathroom is not immediately available, the
student is permitted to have access to a more private
bathroom if available, such as staff bathroom. This will help to
reduce anticipatory anxiety during times of active flare-ups
related to the socially embarrassing nature of some of the IBD
symptoms. If school bathrooms are locked for security
reasons, the student will have access to a key to other
bathrooms closer to the student’s room or lecture hall.
3. University Health Services provide the student with a place to
lie down if necessary during the day.
4. The student will be permitted to carry and drink water, eat
snacks (to treat dry mouth or respond to side effects of
medications) during a course.
5. The student will be permitted to administer his/her own
medications on campus.
a. If for medical reasons the student is not permitted to
administer his/her own medications, the medications
will be left with a UHS nurse, who will administer them
to the student at times consistent with prescribing
b. If UHS staff requires training in administration of the
student’s medication, the Plan Coordinator shall ensure
that UHS staff receives such training within ten
business days of the date of this Plan.
6. Student will be allowed “stop the clock testing.” “Stop the
clock testing” means that, when the student is sitting for a
timed exam, if he/she needs a bathroom break or a break due
to pain, the time for completing the test will be extended by the amount of time the student spends away from the testing
a. This accommodation shall be provided without penalty.
7. If, because of his/her IBD symptoms or medical treatments,
the student is unable to take an exam or submit a major
project on a given day, the exam or major project deadline
will be rescheduled. Cumulative term grades will not be
determined until the student has had opportunity to take the
make-up exam or complete the major project. This
accommodation shall be provided without penalty and apply to
course exams, term papers and projects when reasonably
8. Consideration should be given to the number of major exams
for which the student is required to sit on the same day.
9. It would be the student’s responsibility to advise the Plan
Coordinator of all planned exams by the professors. If an
exam needs to be rescheduled, the Plan Coordinator will
facilitate the student’s efforts with professors.
a. Consideration should be given to the number of major
projects due on the same day.
b. It would be the student’s responsibility to advise the
Plan Coordinator of all planned projects by the
c. If a major project needs to be rescheduled, the Plan
Coordinator will facilitate the student’s efforts with
d. “Major projects” are defined as those that are assigned
more than one week before they are due. If the
student is unable to meet a deadline on any project
due to anything unanticipated related to his/her IBD
symptoms and treatment requirements, the project
deadline will be rescheduled. This accommodation shall
be provided without penalty.
10. The student will be given assistance to help him/her make up
a. Time/lecture halls missed due to the student’s IBD, as
set forth below.
b. After a student notifies professors of symptom
interference with course participation, the Plan
Coordinator will help ensure that , if relevant, each
professor make available an updated syllabus, lesson
plans, new assignments, and copies of all visual aids,
and written homework assignments within 48 hours of
when they were requested by the student. This would
also apply to instances where the student is present,
but unable to take notes due to difficulty concentrating
or writing, or when the student is out of the classroom
to take care of medical or bathroom needs.
11. Any and all make-up work shall be designed to show the
student’s competence in the subject area; quality rather than
quantity of the make-up work shall be emphasized. A professor shall have the right to waive, modify, substitute or
amend assignments so as to facilitate the student’s ability to
catch up on missed work. This accommodation shall be
provided without penalty.
12. The student will not be penalized for tardiness or absences
required for medical appointments and/or illness. If a
professor decides that a portion of a term grade for all
students is awarded based on attendance, the student will
remain eligible for maximum credit of that portion of the grade
if his/her only absences are due to medical appointments
13. Often times, it is difficult to carry heavy books back and forth,
or around to all courses for the length of the day. This may be
relevant if disease activity impacts bone density, or the
student’s weight or causes fatigue. Where available, the
student will be permitted to use an elevator to get to classes
held on various levels of the school in a timely fashion.
14. The student will not be discouraged from engaging fully in all
campus activities, and will not be discouraged from taking
medication on time, eating snacks when medical indicated,
complying with all dietary restrictions, taking bathroom
breaks, or any of the other accommodations set forth above.
All of the provisions of this plan shall be provided without
penalty to the student.
15. Seating will available to the student for easy access to the
classroom door to facilitate bathroom breaks and reduce
anticipatory anxiety. The student may alter location in
professors-assigned classroom seating charts, as well, if a
neighboring student has or appears to have a communicable
16. The university shall notify the student of a known outbreak of
chicken pox or other infectious disease as to which the student
is at a greater risk due either to IBD or immuno-suppressant
17. The student shall be permitted to carry a cellular telephone,
and be allowed to use it in an emergency that precludes the
student from reaching a school telephone to contact medical
18. Any professor or other university personnel having questions
about this Plan shall raise those questions with student first,
and the Plan Coordinator, if necessary. If the Plan Coordinator
believes that there are concerns that are not addressed in this
Plan, the Plan Coordinator shall notify the student and
schedule a meeting that shall include the student.
19. Academic accommodations necessitated by changes in
cognitive functioning due to IBD symptoms/diagnosis must be
addressed and considered separately on a case-by-case basis.
Emergency Contacts In case of a medical emergency, university personnel will notify the
Plan Coordinator, who will call ______________ at the following
Student Plan Coordinator
Dean of Students/representative