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Special Education Forms

The special education forms are designed to ensure that all students with disabilities attending charter schools have available to them a free appropriate public education, which is designed to enable the students to participate fully and independently in the community, including preparation for employment or higher education. The forms include all items required under state and federal regulations.

The forms have been updated to reflect new Chapter 711 regulations, which went into effect on July 1, 2008

Charter schools have many options for obtaining these forms. Click on the document links below to view and download the forms needed.

English, Non-Annotated Forms

Annotated Forms

Foreign Language Forms

English, Non-Annotated Forms:

Displaying Records 1 through 10 of 22 records.

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PROCEDURAL SAFEGUARDS NOTICE - School Age
Material Description:
Material Type:	Forms & Formats
Interest Area(s):	Chapter 14 Chapter 711
File Attachment(s):	View Resource Online (Pdf format 244KB) View Resource Online (Word document format 365KB)
This revised form reflects provisions regarding new supplemental regulations to 34 CFR Part 300, effective December 31, 2008, regarding parental revocation of special education and related services. This revised Procedural Safeguards Notice includes information relating to the parents' action for the revocation of special education and related services. This form is effective beginning December 31, 2008 (with a footer indicating "December 31, 2008a") and replaces the current Procedural Safeguards Notice.

AGREEMENT TO WAIVE REEVALUATION - School Age
Material Description:
Material Type:	Forms & Formats
Interest Area(s):	Chapter 14 Chapter 711
File Attachment(s):	View Resource Online (Pdf format 50KB) View Resource Online (Word document format 27KB)
This form is effective beginning July 1, 2008. This new form is used to obtain parental agreement to waiving a reevaluation. This request previously was included in the "Permission to Reevaluate/Agreement to Waive Reevaluation" form.

Bureau of Special Education Complaint Form and Information packet
Material Description:
Material Type:	Forms & Formats
Interest Area(s):	Parents Alternative Dispute Resolution Options Chapter 14 Chapter 711 Office for Dispute Resolution (ODR) Individuals with Disabilities Education Act 2004
File Attachment(s):	View Resource Online (Pdf format 69KB)
This form is used to submit a formal complaint to the PA Department of Education, Bureau of Special Education (BSE) - Division of Compliance. This form replaces the Consumer Request Intake form which had been used prior to October 13, 2006. The first link will provide access to the actual complaint form, which can be downloaded. It must be properly completed and signed before sending it to the BSE. The second link provides important information about the complaint process. You may find this information to be useful before completing the complaint form. If you need more information about the complaint process or if you are unable to print the form and would like to receive a complaint form by mail, please contact the Special Education ConsultLine at 1-800-879-2301 (within the state of Pennsylvania) or 717-541-4960 ext. 3332.

COMMUNICATION PLAN - School Age
Material Description:
Material Type:	Forms & Formats
Interest Area(s):	Chapter 14 Chapter 711
File Attachment(s):	View Resource Online (Pdf format 56KB) View Resource Online (Word document format 122KB)
This form is effective beginning July 1, 2008. This communication plan must be included in the IEP of any student who is deaf or hard of hearing.

EVALUATION REPORT (ER) - School Age
Material Description:
Material Type:	Forms & Formats
Interest Area(s):	Chapter 14 Chapter 711
File Attachment(s):	View Resource Online (Pdf format 671KB) View Resource Online (Word document format 138KB)
This form is effective beginning July 1, 2008 and reflects new provisions of revised Chapters 14 and 711. This new Evaluation Report (with a footer indicating "July 2008 Revisions") replaces the current ER.

INDIVIDUALIZED EDUCATION PROGRAM (IEP) - School Age
Material Description:
Material Type:	Forms & Formats
Interest Area(s):	Chapter 14 Chapter 711
File Attachment(s):	View Resource Online (Pdf format 114KB) View Resource Online (Word document format 241KB)
Revised IEP June 2010 - Local Education Agencies (LEAs) should begin to use the revised Section IV: State and Local Assessments IEP format as soon as possible, but must use the new format for any IEP developed on or after June 1, 2010. Section IV State and Local Assessments is the only section of the IEP that has been revised and indicates that the PSSA-Modified Science is available for grades 8 and 11 only.

INTENT TO REGISTER - Kindergarten Age Eligible
Material Description:
Material Type:	Forms & Formats
Interest Area(s):	Early Intervention - Preschool Chapter 711 Chapter 14 Early Intervention Transition
File Attachment(s):	View Resource Online (Pdf format 20KB) View Resource Online (Word document format 44KB)
Transition from Preschool Early Intervention to School Age Program - The Preschool Early Intervention program is to provide this form to the parent at the Transition meeting (that is to be held by the end of February) and is to be completed jointly by the preschool and the school district or charter school. 10/2009

INTENT TO REGISTER -First Grade Eligible (Age of Beginners)
Material Description:
Material Type:	Forms & Formats
Interest Area(s):	Early Intervention - Preschool Chapter 711 Chapter 14 Early Intervention Transition
File Attachment(s):	View Resource Online (Pdf format 20KB) View Resource Online (Word document format 44KB)
Transition from Preschool Early Intervention to School Age Program - The Preschool Early Intervention program is to provide this form to the parent at the Transition meeting (that is to be held by the end of February) and is to be completed jointly by the preschool and the school district or charter school. 10/2009

INVITATION TO PARTICIPATE IN THE IEP TEAM MEETING OR OTHER MEETING - School Age
Material Description:
Material Type:	Forms & Formats
Interest Area(s):	Chapter 14 Chapter 711
File Attachment(s):	View Resource Online (Pdf format 41KB) View Resource Online (Word document format 82KB)
This form is effective beginning July 1, 2008 and reflects new provisions of revised Chapters 14 and 711. This new Invitation (with a footer indicating "July 2008 Revisions") replaces the current Invitation. This Invitation no longer contains the request for parental consent to excuse members of the IEP team from attending the IEP team meeting. This request now is made with a separate form, "Parental Consent to Excuse Members from Attending the IEP Team Meeting."

January 8, 2008 Penn Link - Supplement to IEP Form
Material Description:
Material Type:	PublicationsForms & Formats
Interest Area(s):	IEP Facilitation Gaskin Chapter 14 Chapter 711
File Attachment(s):	View Resource Online (Pdf format 13KB)
This Penn*LINK announces the release of a supplement to the IEP Form for use beginning February 1, 2008. The IEP Supplement is posted at www. pattan.net under Regulations and Forms - Chapter 14 - School Age Forms www.pattan.net/files/Memos/Pennlink010808b.pdf and www.pattan.net/files/Memos/Pennlink010808b.doc