School 504 Plans During Childhood Cancer

School staff use "504" and "IEP" as if they mean the same thing. They do not. The two come from different federal laws. They are earned in different ways, and they give a family different rights.

Section 504 of the Rehabilitation Act of 1973 is a civil rights law. It covers any school district that takes federal money. It sends the district no extra funding. It bans discrimination, and it requires a free appropriate public education for a student with a disability.

The Individuals with Disabilities Education Act, or IDEA, is a funding law. It pays for special education and related services. To qualify, a child must fit one of thirteen categories. The result is a written plan called an IEP.

A student may qualify under one law, both, or neither. The Department of Education notes that a student with an IEP does not also need a Section 504 plan. That student is still protected by Section 504.

Under Section 504, a person has a disability if they have a physical or mental impairment that substantially limits a major life activity. Having a record of one counts. So does being regarded as having one.

The list of major life activities is wider than most families expect. The Department of Education's parent guide names caring for oneself, seeing, hearing, eating, sleeping, walking, and working. It then adds major bodily functions as major life activities in their own right, including:

• Normal cell growth.
• The immune system.
• The endocrine system.
• The respiratory, circulatory, and digestive systems.
• The reproductive and neurological systems.
• Bowel, bladder, and brain function.

Read that list again. Normal cell growth. The immune system. A child in cancer treatment fits plainly, and you do not have to prove that grades fell first.

One more rule helps you. Schools may not count the helpful effects of mitigating measures when they decide whether an impairment substantially limits a major life activity. The only exception is ordinary glasses or contact lenses. A child whose anti-nausea medicine is working still has a disability under this test.

Cancer is not one of IDEA's thirteen categories. The usual door in is "other health impairment."

The federal rule defines it as limited strength, vitality, or alertness. That includes heightened alertness to things in the environment, which leaves the child with limited alertness in school. It must come from a chronic or acute health problem. It must also harm school performance. The rule gives examples, and leukemia is named in the text.

IDEA carries a second duty called Child Find. Districts must identify, locate, and evaluate children who may have a disability and need special education. The rule expressly includes children who are advancing from grade to grade. So "his report card looks fine" is not a lawful reason to skip an evaluation.

Ask for a 504 plan when the child mainly needs the setting changed. That covers attendance, rest, medicine at school, infection precautions, and extra time.

Ask for an IDEA evaluation when the teaching itself has to change. That is common after a brain tumor, after radiation to the brain, or after high-dose methotrexate. Attention, memory, speed, and math can all shift.

You do not have to pick in advance. Request both in the same letter.

Do this in writing. Email counts, and the date on it matters.

Send it to the principal, the district 504 coordinator, and the director of special education. Say that you request an evaluation under both Section 504 and IDEA. Name the diagnosis. Attach the oncology team's letter listing restrictions.

Under IDEA, a parent or the district may ask for an initial evaluation. It must be done within 60 days after the district gets your written consent, unless your state sets a different limit. Sign consent forms fast and keep a dated copy. Your signature starts the clock.

Evaluations are free. The Department of Education's guide says districts must conduct Section 504 evaluations at no cost to the parent or student. If a medical assessment is needed to decide, the district must make sure the student gets it at no cost.

Under IDEA, special education itself is defined as specially designed instruction at no cost to parents. Districts may still charge the small fees every student pays, such as a shared lab fee.

If someone hints that you should buy a private evaluation before the school will act, ask them to put that in writing.

For Section 504, a group makes the call. Its members must know the student, know what the evaluation data mean, and know the placement options. The evaluation must draw on several sources, not one test.

For an IEP, the federal rule names the team:

• The parents.
• At least one regular education teacher of the child.
• At least one special education teacher or provider.
• A district representative who can provide specially designed instruction, knows the general curriculum, and knows district resources.
• Someone who can explain what the evaluation results mean for teaching.
• Other people with useful knowledge, invited by the parent or the district.
• The child, whenever that is appropriate.

That sixth line is your opening. Invite the school nurse. Ask the oncology social worker or nurse to join by phone.

Write it so a substitute teacher could follow it in October, when you are not there.

• Treatment absences are excused, with a set way to make up work.
• Late starts and partial days are allowed, with no attendance penalty.
• Rest breaks are allowed, and there is a named place to rest.
• Extra time on tests and homework. Shorter assignments. Teacher's notes given. A scribe for long writing. Verbal testing when needed. St. Jude lists all of these among common accommodations.
• Elevator use, a locker near class, early hall passes, and a second set of books at home.
• Medicine at school: which ones, who gives them, where they are kept.
• Same-day phone call to the parent if chickenpox, shingles, or measles turns up in the building.
• Gym limits. No contact sports while a central line or port is in place. Permission to wear a hat.
• Testing accommodations worded so they carry over to state and college entrance tests.
• A trigger: after a set number of days missed in a row, homebound instruction begins.

Ask for the plan in writing. The rules do not force a district to write a 504 plan. But the Office for Civil Rights encourages districts to document services in writing to avoid confusion, and a document is what you can enforce.

This is a real service, not a courtesy. IDEA defines special education as instruction that may happen in the classroom, in the home, in hospitals and institutions, and in other settings.

To request it, write to the special education office or the 504 coordinator. Ask for the district's homebound instruction form. It usually needs a doctor's signature and an expected length of absence.

Then pin down five things:

• How many hours a week?
• What is the start date?
• Who teaches, and where?
• Do those hours count as attendance?
• How do the hours taper as the child returns part time?

If the hospital runs a school program, ask that teacher to call the district directly.

Ask for the refusal in writing, with the reason.

Section 504 gives you procedural safeguards. They include:

• Notice of decisions.
• A chance to review your child's records.
• An impartial due process hearing, where you may take part and bring a lawyer.
• A review procedure after the hearing.

You may request that hearing when you disagree about identification, evaluation, or placement. You may also file a complaint with the Department of Education's Office for Civil Rights. IDEA gives you parallel dispute rights.

Either way, the first move is the same. Get it in writing, keep every date, and do not let a spoken "we don't do that here" become the record.

Start with Talking to Teachers About Childhood Cancer for the conversation and Returning to School After Cancer for re-entry. Also useful: Childhood Cancer Late Effects: Questions for Follow-Up, Late Effects of Childhood Cancer Treatment, Questions to Ask About Childhood Cancer Treatment, and Siblings and Hospital Days During Childhood Cancer.

• Parent and Educator Resource Guide to Section 504 in Public Elementary and Secondary Schools (PDF), U.S. Department of Education
• Frequently Asked Questions: Section 504 Free Appropriate Public Education (FAPE), U.S. Department of Education
• The Civil Rights of Students with Hidden Disabilities and Section 504, U.S. Department of Education
• IDEA Sec. 300.8(c)(9), Other Health Impairment, U.S. Department of Education
• IDEA Sec. 300.39, Special Education, U.S. Department of Education
• IDEA Sec. 300.111, Child Find, U.S. Department of Education
• IDEA Sec. 300.301, Initial Evaluations, U.S. Department of Education
• IDEA Sec. 300.321, IEP Team, U.S. Department of Education
• Classroom Accommodations for Children and Teens with Illnesses, Together by St. Jude
• School Support During Chronic Illness, Together by St. Jude
• American Cancer Society — Going to School During and After Cancer Treatment
• U.S. Department of Justice — Guide to Disability Rights Laws
• National Cancer Institute — Cancer in Children and Adolescents