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:5/16/2018 1:42:31 PM
This is the Spanish version of the Parent’s Rights Agreement form that summarizes the parent and child’s rights during the Early Intervention process.
Age:Infant/Toddler
Language:Spanish
Effective Date:
The Early Intervention Communication Plan for use as of November 2019. The plan has detailed discussion points that families with children who are deaf or hard of hearing and IFSP or IEP team members should consider during plan development. Information in the plan addresses language and communication needs; communication options, opportunities for direct communication; and progress, assistive technology, devices and services. It also provides a glossary of terms for use.
Age:Infant/Toddler,Preschool
Language:English
Effective Date:11/15/2019 12:00:00 AM
The Chinese version of the Early Intervention Communication Plan has detailed discussion points that families with children who are deaf or hard of hearing and IFSP or IEP team members should consider during plan development. Information in the plan addresses language and communication needs; communication options, opportunities for direct communication; and progress, assistive technology, devices and services. It also provides a glossary of terms for use.
Age:Infant/Toddler,Preschool
Language:Chinese
Effective Date:11/15/2019 12:00:00 AM
The French version of the Early Intervention Communication Plan has detailed discussion points that families with children who are deaf or hard of hearing and IFSP or IEP team members should consider during plan development. Information in the plan addresses language and communication needs; communication options, opportunities for direct communication; and progress, assistive technology, devices and services. It also provides a glossary of terms for use.
Age:Preschool,Infant/Toddler
Language:French
Effective Date:11/15/2019 12:00:00 AM
The Nepali version of the Early Intervention Communication Plan has detailed discussion points that families with children who are deaf or hard of hearing and IFSP or IEP team members should consider during plan development. Information in the plan addresses language and communication needs; communication options, opportunities for direct communication; and progress, assistive technology, devices and services. It also provides a glossary of terms for use.
Age:Infant/Toddler,Preschool
Language:Nepali
Effective Date:11/15/2019 12:00:00 AM
The Portuguese version of the Early Intervention Communication Plan has detailed discussion points that families with children who are deaf or hard of hearing and IFSP or IEP team members should consider during plan development. Information in the plan addresses language and communication needs; communication options, opportunities for direct communication; and progress, assistive technology, devices and services. It also provides a glossary of terms for use.
Age:Infant/Toddler,Preschool
Language:Portuguese
Effective Date:11/15/2019 12:00:00 AM
The Russian version of the Early Intervention Communication Plan has detailed discussion points that families with children who are deaf or hard of hearing and IFSP or IEP team members should consider during plan development. Information in the plan addresses language and communication needs; communication options, opportunities for direct communication; and progress, assistive technology, devices and services. It also provides a glossary of terms for use.
Age:Infant/Toddler,Preschool
Language:Russian
Effective Date:11/15/2019 12:00:00 AM
The Spanish version of the Early Intervention Communication Plan has detailed discussion points that families with children who are deaf or hard of hearing and IFSP or IEP team members should consider during plan development. Information in the plan addresses language and communication needs; communication options, opportunities for direct communication; and progress, assistive technology, devices and services. It also provides a glossary of terms for use.
Age:Infant/Toddler,Preschool
Language:Spanish
Effective Date:1/1/0001 12:00:00 AM
This form allows parents to choose whether to give consent for the Local Educational Agency (LEA) to access reimbursement from Medical Assistance for special education services.
Age:Preschool,Infant/Toddler
Language:English
Effective Date:10/1/2016 12:00:00 AM
This Arabic version of the form allows parents to choose whether to give consent for the Local Educational Agency (LEA) to access reimbursement from Medical Assistance for special education services.
Age:Preschool,Infant/Toddler
Language:Arabic