PaTTAN




			PaTTAN is an initiative of the Pennsylvania Department of Education working in partnership with families and local education agencies to support programs and services to improve student learning and achievement.
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Preschool EI Forms

The Department of Education, Office of Child Development and Early Learning (OCDEL), preschool early intervention program has a variety of standardized forms that meet necessary state and federal requirements. These forms are designed to ensure that preschool children with disabilities receive a free, appropriate, public education. Click on the document links below to view and download the forms needed.

English, Non-Annotated Forms:

Displaying Records 1 through 10 of 18 records.

First Page

Last Page

Due Process Complaint Notice
Material Description:
Material Type:	Forms & Formats
Interest Area(s):	Chapter 14 Office for Dispute Resolution (ODR) Chapter 711 Early Intervention - Preschool ODR - Due Process
File Attachment(s):	View Resource Online (Pdf format 37KB)
Due Process Complaint Notice

Mediation Request Form
Material Description:
Material Type:	Forms & Formats
Interest Area(s):	Chapter 14 Office for Dispute Resolution (ODR) Chapter 711 Early Intervention - Preschool ODR - Mediation
File Attachment(s):	View Resource Online (Pdf format 37KB)
Mediation Request Form

PROCEDURAL SAFEGUARDS Notice
Material Description:
Material Type:	Forms & Formats
Interest Area(s):	Chapter 14 Chapter 711 Early Intervention - Preschool
File Attachment(s):	View Resource Online (Pdf format 181KB) View Resource Online (Word document format 143KB)
PROCEDURAL SAFEGUARDS NOTICE These forms are based on changes to the Individuals with Disabilities Education Act (IDEA) as amended in 2004. This form is effective beginning July 1, 2005. The request form is not attached to this document. It can be downloaded from the School-Age Forms and/or Preschool EI Forms page on the PaTTAN website. PLEASE NOTE that the correct PSN form was posted on this website in June. However, for a brief period of time this summer, due to an undetected technology glitch, an earlier version was inadvertently posted. There was a slight difference in the two versions, specifically in the "Civil action" paragraph at the bottom of page 8. The correct version has been reinstated. LEAs should check to ensure that they are using the correct version.

PILOT ER - Evaluation Report
Material Description:
Material Type:	Forms & Formats
Interest Area(s):	Early Intervention - Infant/Toddler Early Intervention - Preschool
File Attachment(s):	View Resource Online (Pdf format 80KB)
This form is currently being piloted in early intervention programs selected by the Office of Child Development and Early Learning. The forms should not be used by other programs. Statewide use of the form is targeted for July 2008.

PILOT ER - Evaluation Report Hyperlinked
Material Description:
Material Type:	Forms & Formats
Interest Area(s):	Early Intervention - Infant/Toddler Early Intervention - Preschool
File Attachment(s):	View Resource Online (Word document format 137KB)
This form is currently being piloted in early intervention programs selected by the Office of Child Development and Early Learning. The forms should not be used by other programs. Statewide use of the form is targeted for July 2008.

PILOT IFSP / IEP
Material Description:
Material Type:	Forms & Formats
Interest Area(s):	Early Intervention - Infant/Toddler Early Intervention - Preschool
File Attachment(s):	View Resource Online (Pdf format 107KB)
This form is currently being piloted in early intervention programs selected by the Office of Child Development and Early Learning. The forms should not be used by other programs. Statewide use of the form is targeted for July 2008.

PILOT IFSP / IEP Hyperlinked
Material Description:
Material Type:	Forms & Formats
Interest Area(s):	Early Intervention - Infant/Toddler Early Intervention - Preschool
File Attachment(s):	View Resource Online (Word document format 172KB)
This form is currently being piloted in early intervention programs selected by the Office of Child Development and Early Learning. The forms should not be used by other programs. Statewide use of the form is targeted for July 2008.

Preschool Early Intervention Sample Contract and Contract Specifics
Material Description:
Material Type:	Forms & Formats
Interest Area(s):	Early Intervention - Preschool
File Attachment(s):	View Resource Online (Word document format 29KB) View Resource Online (Word document format 25KB)
Sample Preschool Early Intervention Contract Template and Exhibit A document for use when subcontracting with any agency for the provision of services on behalf of the MAWA holder.

EARLY INTERVENTION - EVALUATION REPORT
Material Description:
Material Type:	Forms & Formats
Interest Area(s):	Early Intervention - Preschool
File Attachment(s):	View Resource Online (Word document format 82KB) View Resource Online (Pdf format 50KB)
These forms are based on changes to the Individuals with Disabilities Education Act (IDEA) as amended in 2004. This form is effective beginning July 1, 2005.

EARLY INTERVENTION - Individualized Education Program (IEP)
Material Description:
Material Type:	Forms & Formats
Interest Area(s):	Early Intervention - Preschool
File Attachment(s):	View Resource Online (Word document format 128KB) View Resource Online (Pdf format 81KB)
These forms are based on changes to the Individuals with Disabilities Education Act (IDEA) as amended in 2004. This form was corrected February 13, 2007.