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.

Results 351-360 of 461
Procedural Safeguards Notice - Preschool Early Intervention - Arabic VERSION cover image

Procedural Safeguards Notice - Preschool Early Intervention - Arabic VERSION

Effective Date:1/1/0001 12:00:00 AM
Arabic Version of the Procedural Safeguards Notice - Preschool Early Intervention.
Age:Preschool
Language:Arabic
Procedural Safeguards Notice - Preschool Early Intervention - Japanese VERSION cover image

Procedural Safeguards Notice - Preschool Early Intervention - Japanese VERSION

Effective Date:11/30/2014 11:00:00 PM
Procedural Safeguards Notice – Preschool Early Intervention form revised June 2009. The request forms for mediation and due process hearing are included as Appendix B in this document. They can also be downloaded from the Preschool EI Forms page on the PaTTAN website. Japanese Version.
Age:Preschool
Language:Japanese
Procedural Safeguards Notice - Preschool Early Intervention - Nepali cover image

Procedural Safeguards Notice - Preschool Early Intervention - Nepali

Effective Date:12/1/2014 1:41:16 PM
This is the Nepali Version of the Procedural Safeguards Notice, the letter explaining to a parent their rights and their child’s rights related to Early Intervention services.
Age:Preschool
Language:Nepali
Procedural Safeguards Notice - Preschool Early Intervention - Russian VERSION cover image

Procedural Safeguards Notice - Preschool Early Intervention - Russian VERSION

Effective Date:1/1/0001 12:00:00 AM
Russian Version of the Procedural Safeguards Notice - Preschool Early Intervention.
Age:Preschool
Language:Russian
Procedural Safeguards Notice - Preschool Early Intervention - Vietnamese VERSION cover image

Procedural Safeguards Notice - Preschool Early Intervention - Vietnamese VERSION

Effective Date:1/1/0001 12:00:00 AM
Vietnamese Version of the Procedural Safeguards Notice - Preschool Early Intervention.
Age:Preschool
Language:Vietnamese
Procedural Safeguards Notice - Preschool Early Intervention French Version cover image

Procedural Safeguards Notice - Preschool Early Intervention French Version

Effective Date:1/1/0001 12:00:00 AM
The request forms for mediation and due process hearing are included as Appendix B in this document.
Age:Preschool
Language:French
PROCEDURAL SAFEGUARDS NOTICE - School Age - Hungarian cover image

PROCEDURAL SAFEGUARDS NOTICE - School Age - Hungarian

Effective Date:
ÉRTESÍTÉS ELJÁRÁSI GARANCIÁKRÓL The Procedural Safeguards Notice includes a full explanation of all of the rights available to parents of a child with a disability ages 3-21 when their child has been referred for or is receiving special education services. This model form provides a format that LEAs may choose to use to provide information about procedural safeguards to parents. This revised Procedural Safeguards Notice includes additional resources for parents in Appendix A. The revised form contains the footer “January 6, 2011.”
Age:School Age
Language:Hungarian
PROCEDURAL SAFEGUARDS NOTICE - School Age (French) cover image

PROCEDURAL SAFEGUARDS NOTICE - School Age (French)

Effective Date:7/1/2018 12:00:00 AM
AVIS DE SAUVEGARDE DE PROCÉDURE - Âge Scolaire The Procedural Safeguards Notice includes a full explanation of all the rights available to parents of a child with a disability ages 3-21 when their child has been referred for or is receiving special education services. This model form provides a format that LEAs may choose to use to provide information about procedural safeguards to parents. This revised Procedural Safeguards Notice 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. Also, this revised notice includes additional resources for parents in Appendix A. In addition, this document contains a revised Office for Dispute Resolution (ODR) Request Form for IEP/IFSP/GIEP Facilitation, Mediation, and a revised Due Process Compliant Request Form in Appendix B. The revised Procedural Safeguards Notice contains the footer “July 2018.” This notice is available in two formats - a Word document and a pdf. Below is the request form for Mediation, IEP/IFSP/GIEP Facilitation and the Due Process Complaint form. The form can be submitted via mail, fax or email; contact information can be found at the bottom of each form. Requests can also be submitted via the online submission form on ODR’s website. Mediation & IEP/IFSP/GIEP Facilitation Request (English) - http://odr-pa.org/iep-ifsp-med-request-form-english/ Mediation & IEP/IFSP/GIEP Facilitation (Spanish) – http://odr-pa.org/mediation-iep-online-request-spanish/ Due Process Complaint (English) - http://odr-pa.org/due-process-online-request/ Due Process Complaint (Spanish) - http://odr-pa.org/due-process-online-request-spanish/ *Note: The online submission forms can be accessed in 11 other languages via the ODR website. They include Albanian, Arabic, Chinese Simplified, Chinese Traditional, French, German, Italian, Japanese, Korean, Russian and Portuguese.
Age:School Age
Language:French
PROCEDURAL SAFEGUARDS NOTICE - School Age (Vietnamese) cover image

PROCEDURAL SAFEGUARDS NOTICE - School Age (Vietnamese)

Effective Date:7/1/2018 12:00:00 AM
THÔNG BÁO VỀ CÁC BIỆN PHÁP BẢO VỆ THEO QUY TRÌNH - Độ tuổi đến trường The Procedural Safeguards Notice includes a full explanation of all the rights available to parents of a child with a disability ages 3-21 when their child has been referred for or is receiving special education services. This model form provides a format that LEAs may choose to use to provide information about procedural safeguards to parents. This revised Procedural Safeguards Notice 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. Also, this revised notice includes additional resources for parents in Appendix A. In addition, this document contains a revised Office for Dispute Resolution (ODR) Request Form for IEP/IFSP/GIEP Facilitation, Mediation, and a revised Due Process Compliant Request Form in Appendix B. The revised Procedural Safeguards Notice contains the footer “July 2018.” This notice is available in two formats - a Word document and a pdf. Below is the request form for Mediation, IEP/IFSP/GIEP Facilitation and the Due Process Complaint form. The form can be submitted via mail, fax or email; contact information can be found at the bottom of each form. Requests can also be submitted via the online submission form on ODR’s website. Mediation & IEP/IFSP/GIEP Facilitation Request (English) - http://odr-pa.org/iep-ifsp-med-request-form-english/ Mediation & IEP/IFSP/GIEP Facilitation (Spanish) – http://odr-pa.org/mediation-iep-online-request-spanish/ Due Process Complaint (English) - http://odr-pa.org/due-process-online-request/ Due Process Complaint (Spanish) - http://odr-pa.org/due-process-online-request-spanish/ *Note: The online submission forms can be accessed in 11 other languages via the ODR website. They include Albanian, Arabic, Chinese Simplified, Chinese Traditional, French, German, Italian, Japanese, Korean, Russian and Portuguese.
Age:School Age
Language:Vietnamese
Procedural Safeguards Notice (Bengali) cover image

Procedural Safeguards Notice (Bengali)

Effective Date:4/13/2023 8:04:21 AM
Age:School Age
Language:Bengali