School-Age Forms

School-age forms are designed to ensure that students with disabilities receive a free, appropriate, public education. The forms include all items required under state and federal regulations.

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

PROCEDURAL SAFEGUARDS NOTICE - School Age

Material Type:	Forms & Formats
Interest Area(s):	Chapter 14 Chapter 711
File Attachment(s):	View Resource Online (Pdf format 337KB) View Resource Online (Word document format 414KB)
Material Description:
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.

---

REEVALUATION REPORT (RR) - School Age

Material Type:	Forms & Formats
Interest Area(s):	Chapter 14 Chapter 711
File Attachment(s):	View Resource Online (Pdf format 95KB) View Resource Online (Word document format 224KB)
Material Description:
This form is effective beginning July 1, 2008 and reflects new provisions of revised Chapters 14 and 711. This new Reevaluation Report (with a footer indicating "July 2008 Revisions") replaces the current Reevaluation Report.

---

SUMMARY OF ACADEMIC ACHIEVEMENT AND FUNCTIONAL PERFORMANCE - School Age

Material Type:	Forms & Formats
Interest Area(s):	Chapter 14 Chapter 711
File Attachment(s):	View Resource Online (Pdf format 30KB) View Resource Online (Word document format 62KB)
Material Description:
This form is effective beginning July 1, 2008. This revised Summary of Academic Achievement and Functional Performance (with a footer indicating "July 2008 Revisions") replaces the current Summary of Student Performance.

---

SUMMARY OF CHANGES TO SPECIAL EDUCATION FORMS

Material Type:	Forms & FormatsTraining Materials
Training Date:	6/9/2008
Interest Area(s):	Chapter 14 Chapter 711
File Attachment(s):	View Resource Online (Pdf format 54KB)
Material Description:
This document lists changes that have been made to each of the special education forms. The forms are effective beginning July 1, 2008.

---

AGREEMENT TO WAIVE REEVALUATION - School Age

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)
Material Description:
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 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)
Material Description:
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 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)
Material Description:
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 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)
Material Description:
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 Type:	Forms & Formats
Interest Area(s):	Chapter 14 Chapter 711
File Attachment(s):	View Resource Online (Pdf format 111KB) View Resource Online (Word document format 243KB)
Material Description:
This revised IEP contains the new Participation in State and Local Assessments page, which reflects the Pennsylvania System of School Assessment - Modified Math Assessment (PSSA-M) option for students eligible for participation in the PSSA-M. This IEP contains the footer indicating "October 2009 Revisions." All students who take the PSSA-M must meet eligibility criteria and have a standards-aligned IEP.

---

INTENT TO REGISTER - Kindergarten Age Eligible

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)
Material Description:
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

---

---

Request for Public Records

© 2010 PaTTAN