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Parent Resources » MTPS Parent Referral for 504

MTPS Parent Referral for 504




Section 504 defines a qualified individual with a disability as anyone who:


  • Has a mental or physical impairment which substantially limits one or more major life activities (e.g., caring for oneself, performing manual tasks, walking, seeing, hearing, speaking, breathing, learning, and working);
  • Has a record of such an impairment; or
  • Is regarded as having such impairment.


If you believe your child may qualify for a 504 plan based on the information to be provided (as indicated above), you can request an Initial Eligibility Determination Meeting for your child by submitting a letter to the Marlboro Special Services Department. This request can be sent to your child’s school, to the attention of the School Counselor.  


Your request must have a statement similar to, “I am requesting a 504 plan for my child.” It is preferred, but not required, that you include information about your child and why you are requesting the evaluation. The request must include the following information: 

  1. Parent name;
  2. Parent phone number;
  3. Parent address;
  4. Child’s full name;
  5. Child’s date of birth; and
  6. Child’s grade and school.

In addition to a parent letter of request, the parent must also provide supporting documentation from the outside professional/evaluator, stating their child’s diagnosis.  This documentation should include as much of the following information as possible, including but not limited to the following:

  1. Specify the diagnosis of disability
  2. Describe how the disability affects a major life activity such as hearing, walking, seeing, speaking, breathing, learning or working
  3. Date of evaluation and/or visit
  4. Educational, developmental and relevant medical history
  5. List of administered tests with all scores, including subtest scores
  6. Description of the functional limitations resulting from the disability
  7. Recommendation for specific accommodations requested
  8. Explanation of how test results support the need for requested accommodations
  9. Examiners professional credentials cited and appropriate for the diagnosed disability

In order for your request to be processed, your letter must have an original signature. You can submit this letter two ways:

  1. Mail directly to your child’s school
  1. Sign, Scan, Attach and email to your child’s School Counselor/ 504 Building Liaison (contacts listed below)

**Please note that emails without an original signature will not be accepted.**

School Name

Building 504 Liaison

Email Address

Phone Number

Abbott Early Learning Center

Al Perno 

(Building Principal)

[email protected]

(732) 972-7100

ext: 6064

Asher Holmes Elementary

Carol Colao

[email protected]

(732) 972-2080 

ext. 6160

Defino Central Elementary

Rebecca Nicholes

[email protected]

(732) 972-2099 

ext. 6260

Dugan Elementary

Lindsay Bulawa

[email protected]

(732) 972-2110 

ext. 6360

Marlboro Elementary

Michele Mondoro

[email protected]

(732) 972-2095 

ext. 6460

Robertsville Elementary

Chrissy Tongring

[email protected]

(732) 972-2044

 ext. 6560

Marlboro Middle School

Jaclyn Sabo

[email protected]

(732) 972-2100

ext. 6715

Marlboro Memorial Middle School

Shoshana Baskind

[email protected]

(732) 972-7115

ext. 6920

District 504 Coordinator

Maryelizabeth Tirone 

Director of Special Services



What happens next?


Your child’s School Counselor/504 Building Liaison (or other appropriate building representative) will contact you regarding next steps.