If you’ve ever searched “sample 504 plan for ADHD,” you were probably hoping to see what one actually looks like — not just a list of possible accommodations.

Teachers often want a clear structure they can follow. Parents want to know whether the draft they were handed is complete. Both are trying to answer the same question: what should a 504 plan actually include?

This post walks through the essential sections of a 504 plan and gives ADHD-specific examples for each. At the end, you’ll see a full sample plan put together in one place so you can see how the pieces fit. Before we get into it, one important clarification.

There is no single national 504 template. Section 504 is a federal civil rights law, but it does not require schools to use a standardized form. Each district designs its own document. That’s why one plan may be two pages and another may be eight.

The format can vary. The required components cannot. A compliant 504 plan must clearly identify the impairment, explain how it substantially limits a major life activity, and list specific accommodations that provide access.

Now let’s walk through what that looks like in practice. If you are putting together a 504 plan for a student with ADHD, make sure you visit these other resources:

• 504 Accommodations for ADHD: Practical Examples for School Support
• Executive Functioning Accommodations for an IEP or 504 Plan (PDF List)
• IEP Accommodations List: 500+ Examples (for 504 Plans Too)
• What Should Be Included in a 504 Plan + Free Blank 504 Template and Checklist

Let’s start with the basic structure. Even though district forms may look different, most 504 plans follow a similar framework. When you understand the standard components, it becomes much easier to review a draft or create one from scratch.

The first section is straightforward, but it sets the foundation for everything that follows.

Student Information

Every 504 plan begins with basic identifying information. This seems simple, but it establishes the official record of when the plan was created and when it must be reviewed.

This section typically includes:

• Student name
• Grade
• School
• Date of plan
• Review date

ADHD Example:

Student: Jacob Smith
Grade: 5
School Year: 2026–2027
Initial Plan Date: September 15, 2026
Annual Review Date: September 15, 2027

Some districts also include student ID numbers or case manager names here.

Physical or Mental Impairment

Section 504 requires identification of a physical or mental impairment. For ADHD, this is straightforward, but the language should be clear and specific.

ADHD Example: Medical diagnosis of Attention-Deficit/Hyperactivity Disorder (ADHD), Combined Presentation.

Some plans also include the date of diagnosis or documentation source, though that is not required in every district’s form.

Major Life Activity Impacted

This is one of the most important sections — and one that is often written too vaguely.

Under Section 504, the impairment must substantially limit one or more major life activities. For students with ADHD, these often include:

• Concentrating
• Thinking
• Learning
• Organizing
• Completing tasks

The plan should explain how the ADHD affects school functioning.

ADHD Example Language: ADHD substantially limits the student’s ability to sustain attention, initiate tasks independently, organize materials, regulate impulses, and complete assignments within expected time frames. These limitations impact academic performance and classroom participation.

This section connects the diagnosis to real educational impact.

Evaluation Data Reviewed

A 504 plan should reflect the data considered by the team when determining eligibility.

This may include:

• Teacher reports
• Parent input
• Grades and work samples
• Behavioral data
• Medical documentation

ADHD Example: The team reviewed teacher observations, classroom performance data, parent report, medical documentation confirming ADHD diagnosis, and discipline records reflecting impulsivity and off-task behavior.

This section shows that the plan was based on evidence, not assumptions.

504 Accommodation Plan

This is the core of the 504 document. Accommodations should be specific, implementable, and directly connected to the documented areas of limitation.

Vague language such as “provide support as needed” is not helpful.

ADHD Accommodation Examples:

Classroom

• Preferential seating away from high-traffic areas
• Written and verbal directions for assignments
• Scheduled movement breaks

Testing

• Extended time (time and a half)
• Reduced-distraction testing location
• Breaks during long assessments

Homework and Assignments

• Break long-term projects into smaller deadlines
• Reduced repetitive homework when mastery is demonstrated
• Use of assignment checklist

Organization

• Daily planner check with teacher before dismissal
• Weekly binder and backpack organization check

Behavior and Regulation

• Access to break card
• Discreet teacher cue for redirection
• Scheduled check-in/check-out with designated staff member

Each accommodation should be listed clearly, not implied.

Implementation Details

Many plans include a section identifying:

• Where accommodations apply (all classes, specific subjects, testing only)
• Who is responsible for implementation

ADHD Example: Accommodations apply across all academic classes and school-sponsored testing. Classroom teachers are responsible for implementation. Case manager will monitor compliance quarterly.

This prevents confusion about accountability.

Signatures and Review Date

A 504 plan is a team decision. Most forms include:

• Parent/guardian
• School administrator
• Teacher(s)
• Counselor or 504 coordinator

The plan should also list a review date, typically annually. (although annual reviews are not mandated like with IDEA)

Sample 504 Plan for ADHD (Example)

Below is a simplified example combining the sections above.

Student: Jacob Smith
Grade: 5
School Year: 2026–2027
Initial Plan Date: September 15, 2026
Review Date: September 15, 2027

Impairment: Attention-Deficit/Hyperactivity Disorder (ADHD), Combined Presentation.

Major Life Activities Impacted: Concentrating, thinking, learning, organizing, completing tasks.

Impact Statement: Due to ADHD, the student demonstrates difficulty sustaining attention during independent work, initiating multi-step tasks, organizing materials, and regulating impulses during classroom instruction. These limitations interfere with academic performance and timely task completion.

Evaluation Data Reviewed: Medical documentation of ADHD diagnosis, teacher observations, classroom performance data, parent input, discipline records.

Accommodation Plan:

Classroom

• Preferential seating near teacher
• Written and verbal instructions
• Scheduled movement break every 45 minutes

Testing

• Extended time (1.5x)
• Reduced-distraction environment
• Breaks as needed

Homework and Organization

• Daily planner review before dismissal
• Break long-term assignments into weekly checkpoints
• Weekly organization check with teacher

Behavioral Supports

• Discreet cue for redirection
• Access to break card
• Check-in/check-out with counselor twice weekly

Implementation:
All classroom teachers are responsible for implementation. 504 coordinator will review plan effectiveness quarterly.

Signatures:
Parent/Guardian
Administrator
Teacher(s)
504 Coordinator

A 504 plan for ADHD does not need to be complicated–it just needs to be clear.

The most common problems with 504 plans are not missing forms. They are vague language, inconsistent implementation, and accommodations that do not match the actual barriers the student is experiencing.

Whether you are a teacher drafting a plan or a parent reviewing one, focus on three things:

• Is the impact clearly described?
• Are the accommodations specific?
• Is there accountability for implementation?

The format may vary from district to district. The content should not.