Forms
This site includes forms designed by the Pennsylvania Department of Education to ensure that students with disabilities receive a free, appropriate, public education. Forms are available for the Infant-Toddler/Early Intervention, Preschool/Early Intervention, and School-age programs, and include both annotated and non-annotated versions. Forms are available as Word and pdf documents.
Bureau of Special Education Complaint Form
Access the State Complaint Form on PDE's State Complaints and Dispute Resolution page.
State Complaint Forms in other languages are also available on the State Complaints and Dispute Resolution page.
Complaint Resolution Procedures
If you need more information about the complaint process or if you are unable to print the packet and would like to receive a complaint form by mail, please contact the Special Educaton ConsultLine at 1-800-879-2301, ConsultLine@odr-pa.org or submit an online request.
Effective Date:12/1/2018 1:00:00 AM
Infant Toddler Early Intervention Evaluation Report for use as of December 2018. The Evaluation Report documents information on a child and family, including strengths and needs, provides eligibility determinations, and provides recommendations for supports that can assist the young child to develop, learn and grow. This annotated form provides guidance to parents and early intervention staff completing the evaluation report. It is not intended as an exclusive manner for complying with state and/or federal special education statutes and regulations.
Age:Infant/Toddler
Language:English
Effective Date:11/16/2022 12:00:00 AM
Infant Toddler Early Intervention Evaluation Report, Arabic version, documents information on a child and family, including strengths and needs, provides eligibility determinations, and provides recommendations for supports that can assist the young child to develop, learn and grow.
Age:Infant/Toddler
Language:Arabic
Effective Date:11/16/2022 12:00:00 AM
Infant Toddler Early Intervention Evaluation Report, Bengali version, documents information on a child and family, including strengths and needs, provides eligibility determinations, and provides recommendations for supports that can assist the young child to develop, learn and grow.
Age:Infant/Toddler
Language:Bengali
Effective Date:11/16/2022 12:00:00 AM
Infant Toddler Early Intervention Evaluation Report, French version, documents information on a child and family, including strengths and needs, provides eligibility determinations, and provides recommendations for supports that can assist the young child to develop, learn and grow.
Age:Infant/Toddler
Language:French
Effective Date:12/1/2018 10:27:21 AM
Infant Toddler Early Intervention Evaluation Report for use as of December 2018. The Evaluation Report documents information on a child and family, including strengths and needs, provides eligibility determinations, and provides recommendations for supports that can assist the young child to develop, learn and grow.
Age:Infant/Toddler
Language:Haitian Creole
Effective Date:11/16/2022 12:00:00 AM
Infant Toddler Early Intervention Evaluation Report, Nepali version, documents information on a child and family, including strengths and needs, provides eligibility determinations, and provides recommendations for supports that can assist the young child to develop, learn and grow.
Age:Infant/Toddler
Language:Nepali
Effective Date:11/16/2022 12:00:00 AM
Infant Toddler Early Intervention Evaluation Report, Russian version, documents information on a child and family, including strengths and needs, provides eligibility determinations, and provides recommendations for supports that can assist the young child to develop, learn and grow.
Age:Infant/Toddler
Language:Russian
Effective Date:12/1/2018 12:00:00 AM
Early Intervention Evaluation Report in Spanish for use as of December 2018. The Evaluation Report documents information on a child and family, including strengths and needs, provides eligibility determinations, and provides recommendations for supports that can assist the young child to develop, learn and grow.
Age:Infant/Toddler
Language:Spanish
Effective Date:12/1/2018 9:53:50 AM
This abbreviated Infant Toddler Early Intervention Evaluation Report provides local Infant Toddler Early Intervention programs the ability to document the minimum information necessary to determine eligibility for children ineligible for Early Intervention Services, but eligible for tracking services.
Age:Infant/Toddler
Language:English
Effective Date:12/1/2018 12:00:00 AM
This abbreviated Infant Toddler Early Intervention Evaluation Report, Arabic version, provides local Infant Toddler Early Intervention programs the ability to document the minimum information necessary to determine eligibility for children ineligible for Early Intervention Services, but eligible for tracking services.
Age:Infant/Toddler
Language:Arabic