Date:

To: [Name of School 504 Coordinator]
To: [Name of School Principal]

RE: Request For Section 504 Determination & 504 Plan

Dear Administrators:

The purpose of this letter is to request a determination of eligibility for [Child's Name], a student at [Name of School], under Section 504 of the Rehabilitation Act of 1973 and to develop a formal, documented 504 Plan of education. A 504 plan, once determined, might require reasonable accommodations and program modifications so that this student can benefit from public education to the same extent as a student who does not have a disability. This plan would also provide a free appropriate public education [FAPE] under Section 504.

[Child's Name] experiences a disorder called misophonia which substantially limits major life activities and adversely affects their ability to learn and participate in class, preventing equal access to educational opportunities and school programs. 

Misophonia is a complex, multi-disciplinary sensory disorder characterized by strong emotional reactions to specific sounds, often referred to as "trigger sounds." These activating sounds can include chewing, slurping, tapping, pen clicking, plastic or paper crinkling, and many other noises that are commonly heard in a classroom setting. When exposed to these activating sounds, [Child's Name] experiences extreme discomfort, heightened anxiety, and a reduced ability to focus on their academic tasks.

Disabilities are not always visible and can include any mental or cognitive impairment that hinders one’s ability to perform normal life activities such as schooling. Misophonia greatly hinders [Child’s name]’s daily activities and, as such, can qualify as a disability. 

Some examples of [Child’s name]’s specific misophonic activating sounds and stimuli are:

**[List specific triggers for the person with misophonia]

I am providing documentation from licensed medical professionals [and others] that would qualify this student for services under Section 504. I believe this information is more than sufficient for the Section 504 planning team to make the determination of Section 504 eligibility and to develop necessary accommodations in a formal 504 Plan to provide this student with an equal education.

Because of this disability, I am requesting the reasonable accommodations listed below so that this student can participate in school lessons and activities to the same extent as someone without disabilities.

[Some examples of accommodations below. Change to suit your needs.]

Sound-Reducing Headphones/Earplugs: Please allow [Child's Name] to wear noise-canceling headphones and/or earplugs during class to minimize exposure to activating sounds and improve their concentration.

A “No Food or Gum Policy” in Classes Student Attends: If not already in effect, the classes which [Child’s Name] is required to attend should implement a “no-food or chewing gum policy”.

Seating Arrangement: Whenever possible, consider seating [Child's Name] away from sources of noise or distractions, such as doors, windows, or noisy classmates.

Alternative Test and Assessment Arrangements: If a classroom environment with activating sounds affects [Child's Name]'s performance on tests or assessments, provide them with the option to take exams in a quieter, distraction-free space.

Educational Support Plan: Work with [Child's Name]'s educational team to create a formal plan that outlines specific accommodations and strategies tailored to their needs, in compliance with applicable laws and regulations. Educate [Child's Name]'s teachers and classmates about misophonia to foster understanding and empathy within the school community.

Permission to Step Away from Activating Situations, as needed: Allow [Child’s Name] to be able to step outside, away from unexpected activating stimuli to self-regulate, as needed.

I kindly request a meeting to discuss this matter further and to develop a plan that best serves [Child's Name]'s educational needs. I request that the Section 504 Coordinator for the District be present at the initial 504 team meeting to discuss findings, results, and recommendations with the Section 504 team.

Thank you for your attention to this important matter. I am confident that with your support, we can create an inclusive and accommodating learning environment that allows [Child's Name] to reach their full potential. 

Please let me know if you have any questions or concerns. Thank you so much.

Sincerely,

[Your Name]
[Your Signature]

cc: [Child's Name]'s Teacher(s)
[School Counselor]
[Special Education Coordinator, if applicable]

**[Attach documentation or other relevant medical notes of needs.]