1. If you (or your child) are still having symptoms of concussion you may need extra help to perform school-related activities. As your (or your child’s) symptoms decrease during recovery, the extra help or supports can be removed gradually.
2. Inform the teacher(s), school nurse, school psychologist or counselor, and administrator(s) about your (or your child’s) injury and symptoms.
School personnel should be instructed to watch for:
• Increased problems paying attention or concentrating
• Increased problems remembering or learning new information
• Longer time needed to complete tasks or assignments
• Greater irritability, less able to cope with stress
• Symptoms worsen (e.g., headache, tiredness) when doing schoolwork
Until you (or your child) have fully recovered, the following supports are recommended: (check all that apply)
No return to school. Return on (date)
Return to school with following supports. Review on (date)
Shortened day. Recommend ___ hours per day until (date)
Shortened classes (i.e., rest breaks during classes). Maximum class length: _____ minutes.
Allow extra time to complete coursework/assignments and tests.
Lessen homework load by ________%. Maximum length of nightly homework: ______ minutes.
No significant classroom or standardized testing at this time.
Check for the return of symptoms (use symptom table on front page of this form) when doing activities that require a lot of attention or concentration.
Take rest breaks during the day as needed.
Request meeting of 504 or School Management Team to discuss this plan and needed supports.