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<Parent's Name>

<Home Address>

<City, State, ZIP>

<Phone Number>

<Email Address>

<Date>

Attention: <Principal's Name>

<School Name>

<School Address>

<City, State, ZIP>

RE: Request for <child's name> 504 Plan for <School Year>

Dear <Principal>,

The purpose of this letter is to request a 504 Plan for our child <Insert Name, Date of Birth> for the <Insert Year> academic school year. Our child is diagnosed with Food Protein-Induced Enterocolitis Syndrome (FPIES), a rare food allergy of the gastrointestinal tract. <child's name> will be a <grade level> student in <teacher's name> classroom.

FPIES is food allergic disorder that falls under the Section 504/ADA Accommodation Plan. Symptoms of FPIES include delayed onset vomiting, diarrhea, lethargy, and in severe cases, hypovolemic shock. It is not a typical food allergy and does not cause symptoms of hives or anaphylaxis. NOTE: If your child does have an IgE-mediated food allergy, you will need to tailor the letter to state so here.

Attached is our physician's Food Allergy Management Plan that outlines our child's current list of food allergies and emergency action plan. Given the nature of this type of food allergy and its management, it is imperative that a 504 Plan be implemented for the best interest and safety of our child during academic hours and extracurricular activities.

This letter also serves as our consent for <physician's name> to consult with the school nurse and administrators regarding our child's action plan prior to our initial meeting and in the event of an emergency. Attached are our physician's orders and requested 504 special accommodations. At the request of our physician, the school nurse should also write up an Individual Health Plan (IHP).

At our first meeting, we wish to request the presence and input of all school staff members who will have direct supervision and interaction with our child, not limited to nursing staff and the Child Study team responsible for implementing the 504 Plan. We also request the opportunity to provide education about FPIES to staff members who would like to learn more and who will be an integral part of our 504 team.

We are excited for the upcoming school year and request that a 504 Team Meeting be scheduled prior to the start of the school year. We look forward to building a long-term partnership with school staff and collaborating as a cohesive team to ensure <child's name> safety.

We look forward to your response and to finding a mutually agreeable time to meet.

Respectfully,

 

<Parent's Name>

cc:  <Director of Student Services and Special Education>
      <504 On-site Coordinator>

     <School Nurse>

**Note to Parent: Be sure to attach the Food Allergy Management Plan from your child's physician. This plan includes an emergency action plan and the physician's recommended accommodations, including a list of safe and allergic foods.

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