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.

Results 11-20 of 79
Bureau of Special Education Complaint Information Packet and Form cover image

Bureau of Special Education Complaint Information Packet and Form

Effective Date:2/29/2016 11:00:00 PM
This form is used to submit a formal complaint to the PA Department of Education, Bureau of Special Education (BSE) - Division of Compliance. 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 717-901-2146.
Age:School Age
Language:English
Evaluation Report-Annotated cover image

Evaluation Report-Annotated

Effective Date:7/1/2018 8:41:03 AM
This revised Evaluation Report (Annotated) includes a change in terminology that replaces the term “mental retardation” with the term “intellectual disability.” This change also aligns the Commonwealth’s special education regulations in Chapters 14 and 711 to the Individuals with Disabilities Education Act (IDEA) regulatory revisions resulting from Rosa’s Law. The change in terminology does not affect the meaning or the eligibility determination associated with the term. (July 2018)
Age:School Age
Language:English
Agreement to Waive Reevaluation -Annotated cover image

Agreement to Waive Reevaluation -Annotated

Effective Date:7/1/2018 8:41:03 AM
This annotated document describes the contents of the Agreement to Waive Reevaluation form, which is used by the LEA to obtain agreement from the parent to waive a child’s reevaluation. This document also replaces the September 2008 version and includes a change in terminology that replaces the term “mental retardation” with the term “intellectual disability.” This change aligns the Commonwealth’s special education regulations in Chapter 14 and Chapter 711 to the Individuals with Disabilities Education Act (IDEA) regulatory revisions resulting from Rosa’s Law. The change in terminology does not affect the meaning or the eligibility determination associated with the term.
Age:School Age
Language:English
INDIVIDUALIZED EDUCATION PROGRAM (IEP) (ANNOTATED) cover image

INDIVIDUALIZED EDUCATION PROGRAM (IEP) (ANNOTATED)

Effective Date:2/1/2020 8:41:03 AM
This revised annotated form (with footer February 1, 2020) coincides with the February 1, 2020 changes to the Individualized Education Program (IEP) pursuant to section IV of the IEP (the elimination of required video recording and narrative notes for students taking the PASA) per the PENN*LINK issued December 16, 2019.
Age:School Age
Language:English
Reevaluation Report -Annotated cover image

Reevaluation Report -Annotated

Effective Date:7/1/2018 8:41:03 AM
This annotated form described the contents of the revised Reevaluation Report (July 2018), which replaces the July 2008 version and includes a change in terminology that replaces the term “mental retardation” with the term “intellectual disability.” This change also aligns the Commonwealth’s special education regulations in Chapters 14 and 711 to the Individuals with Disabilities Education Act (IDEA) regulatory revisions resulting from Rosa’s Law. The change in terminology does not affect the meaning or the eligibility determination associated with the term.
Age:School Age
Language:English
INTENT TO REGISTER –First Grade Eligible (Age of Beginners) Annotated  cover image

INTENT TO REGISTER –First Grade Eligible (Age of Beginners) Annotated

Effective Date:1/1/0001 12:00:00 AM
This form is effective beginning March 2014. 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. This annotated form offers assistance and guidance to parents and early intervention providers. It is not intended as an exclusive manner for complying with state and/or federal special education statutes and regulations.
Age:School Age,Preschool
Language:English
Notice Of Recommended Educational Placement/Prior Written Notice (NOREP/PWN) For Revocation Of Consent For Special Education Services - School Age  (Annotated)  cover image

Notice Of Recommended Educational Placement/Prior Written Notice (NOREP/PWN) For Revocation Of Consent For Special Education Services - School Age (Annotated)

Effective Date:1/1/0001 12:00:00 AM
The recent supplemental regulations to 34 CFR Part 300, effective December 31, 2008, require that Local Education Agencies provide parents with prior written notice upon parental revocation of consent for the continued provision of special education and related services. This annotated form, revised December 31, 2008, describes how to use the current NOREP/PWN to provide this notice to the parents.
Age:School Age
Language:English
Annotated Guidance for Writing Session Notes  cover image

Annotated Guidance for Writing Session Notes

Effective Date:1/1/0001 12:00:00 AM
This document provides guidance for writing the standardized session note form that is to be used by all Infant/Toddler Early Intervention programs. Updated March 2013.
Age:Infant/Toddler
Language:English
Prior Written Notice for Initial Evaluation and Request for Consent Form (Annotated) - School Age cover image

Prior Written Notice for Initial Evaluation and Request for Consent Form (Annotated) - School Age

Effective Date:3/29/2015 11:00:00 PM
This annotated document describes the new Prior Written Notice for Initial Evaluation and Request for Consent Form, which reflects the requirement that initial evaluations are subject to the IDEA’s notice requirements in 34 CFR Sec. 300.503-300.504, and parental consent requirements in 34 CFR Sec. 300.300. Under 34 CFR Sec. 300.503(a) the local education agency (LEA) must provide written notice to the parents of a child with a disability that describes any evaluation procedures the agency proposes to conduct, and must be given to the parents of a child with a disability a reasonable time before the public agency: (1) Proposes to initiate or change the identification, evaluation or educational placement of the child or the provision of a free appropriate public education (FAPE) to the child; or (2) Refuses to initiate or change the identification, evaluation or educational placement of the child or the provision of FAPE to the child. This Prior Written Notice for Initial Evaluation and Request for Consent Form includes the notice and consent requirements for initial evaluation. This form replaces the Permission to Evaluate – Consent Form (Annotated). It contains the footer, “Revised January 2015.” This new form is effective beginning March 30, 2015.
Age:School Age
Language:English
Prior Written Notice for Reevaluation and Request for Consent Form (Annotated) - School Age cover image

Prior Written Notice for Reevaluation and Request for Consent Form (Annotated) - School Age

Effective Date:3/29/2015 11:00:00 PM
This annotated document describes the new Prior Written Notice for Reevaluation and Request for Consent Form, which reflects the requirement that reevaluations are subject to the IDEA’s notice requirements in 34 CFR Sec. 300.503-300.504, and parental consent requirements in 34 CFR Sec. 300.300. Under 34 CFR Sec. 300.503(a) the local education agency (LEA) must provide written notice to the parents of a child with a disability that describes any reevaluation procedures the agency proposes to conduct, and must be given to the parents of a child with a disability a reasonable time before the public agency: (1) Proposes to initiate or change the identification, evaluation or educational placement of the child or the provision of a free appropriate public education (FAPE) to the child; or (2) Refuses to initiate or change the identification, evaluation or educational placement of the child or the provision of FAPE to the child. This Prior Written Notice for Reevaluation and Request for Consent Form includes the notice and consent requirements for the reevaluation. This form replaces the Permission to Reevaluate – Consent Form (Annotated). It contains the footer, “Revised January 2015.” This new form is effective beginning March 30, 2015.
Age:School Age
Language:English