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)____

University  _______________________________ 

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 

recurrent times.  

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 

day.  

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 

bodily waste. 

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 

stress.  

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 

assistants.   

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 IDEA. 

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 

worst) 

_____ Fatigue 

_____ Nausea 

_____ Vomiting (estimated ___ times per day) 

_____ Student has had surgery (___ times) 

_____ Student has an ostomy or other surgical revision of the 

digestive track 

_____ Student takes medication during the day 

List medications and dosages here: 

_______________________________________________________

_______________________________________________________ 

_______________________________________________________

_______________________________________________________ 

_____ Student has dietary restrictions 

Explain here: 

____________________________________________________ 

_______________________________________________________ 

_______________________________________________________

________________________________________________ 

_____ Student receives treatments/office visits that require absences 

from campus/courses 

Estimated Frequency: every ____ weeks 

Expected duration of absence: ___ days per treatment 

Student requires university personnel assistance with: 

___ medication 

___ dietary needs 

___ ostomy or other pouch emptying and cleaning 

___ Other (specify): 

_____________________________________________ _______________________________________________________

Side effects of student’s particular medications may cause/impact: 

___ Headaches 

___ 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 

penalty. 

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 

instructions.  

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 

room.  

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 

agreed upon. 

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 

professors.  

c. If a major project needs to be rescheduled, the Plan 

Coordinator will facilitate the student’s efforts with 

professors.  

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 

any course 

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 

and/or treatment 

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 

illness. 

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 

medication. 

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 

team members.

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 

telephone number(s): 

Home: _________________ 

Work: _________________ 

Cell: __________________ 

Other: _________________ 

Signed: 

__________________________    

__________________________ 

Student Plan Coordinator 

__________________________     

____________________________ 

Dean of Students/representative      

UHS staff  

Date_____________