Forms

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.

Vietnamese Version of the Infant/Toddler Early Intervention Evaluation Report.

Transition meeting invitation letter for children and families anticipating transition to a community program or leaving early intervention. Form updated 05/09

This form is effective beginning March 2014. This form is used to invite team members to an IEP or other meeting.

Arabic Version of the Preschool Early Intervention Invitation to Participate in the IEP Team Meeting or Other Meeting form.

This form is effective beginning March 2014. This form is used to invite team members to an IEP or other meeting. 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.

This form is effective beginning March 2014. This form is used along with an Invitation to Participate in an IEP Meeting if there are team members who are invited to attend but the program would like to excuse their participation.

Arabic Version of the Preschool Early Intervention Parental Consent to Excuse Members from Attending the IEP Team Meeting form.

This annotated document describes the contents of the Parental Consent to Excuse Members from Attending the IEP Team Meeting form. This form is effective beginning March 2014. This form is used along with an Invitation to Participate in an IEP Meeting if there are team members who are invited to attend but the program would like to excuse their participation. 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.

This form is effective beginning March 2014. This form must be issued by the Local Education Agency to obtain written consent to conduct an initial evaluation.

This form is effective beginning March 2014. This form must be issued by the Local Education Agency to obtain written consent to conduct an initial evaluation. This is the annotated version. 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.

This form is effective beginning March 2014. This form must be issued by the Local Education Agency to obtain written consent to conduct a reevaluation.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.

Letters of invitation for transition to the Preschool EI Program or to other community services. Invitation letters must be sent to the family, Preschool EI Program and other participants no later than 30 days before the scheduled transition meeting date, unless the parties all agree to meet within shorter timelines.

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.

Act 26 Questions and Answers

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.

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.

This form, effective beginning July 1, 2008, is to be used when the Local Education Agency (LEA) seeks to obtain consent from the parent to excuse required members of the IEP team from attending an IEP team meeting.

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.

CONSENSO ALL’ESONERO DELLA RIVALUTAZIONE – 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.

This form, effective beginning July 1, 2008, is to be used when the Local Education Agency (LEA) seeks to obtain consent from the parent to excuse required members of the IEP team from attending an IEP team meeting.

PARENTAL CONSENT TO EXCUSE MEMBERS FROM ATTENDING THE IEP TEAM MEETING - School Age This form, effective beginning July 1, 2008, is to be used when the Local Education Agency (LEA) seeks to obtain consent from the parent to excuse required members of the IEP team from attending an IEP team meeting.

AGREEMENT TO WAIVE REEVALUATION - School Age 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.

AGREEMENT TO WAIVE REEVALUATION - School Age 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.

PARENTAL CONSENT TO EXCUSE MEMBERS FROM ATTENDING THE IEP TEAM MEETING - School Age This form, effective beginning July 1, 2008, is to be used when the Local Education Agency (LEA) seeks to obtain consent from the parent to excuse required members of the IEP team from attending an IEP team meeting.

This form, effective beginning July 1, 2008, is to be used when the Local Education Agency (LEA) seeks to obtain consent from the parent to excuse required members of the IEP team from attending an IEP team meeting.

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.

This form, effective beginning July 1, 2008, is to be used when the Local Education Agency (LEA) seeks to obtain consent from the parent to excuse required members of the IEP team from attending an IEP team meeting.

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.

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.

This form, effective beginning July 1, 2008, is to be used when the Local Education Agency (LEA) seeks to obtain consent from the parent to excuse required members of the IEP team from attending an IEP team meeting.

This form, effective beginning July 1, 2008, is to be used when the Local Education Agency (LEA) seeks to obtain consent from the parent to excuse required members of the IEP team from attending an IEP team meeting.

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.

This form, effective beginning July 1, 2008, is to be used when the Local Education Agency (LEA) seeks to obtain consent from the parent to excuse required members of the IEP team from attending an IEP team meeting.

This revised Procedural Safeguards Letter (with a footer indicating “July 2018 Revisions”) replaces the current Procedural Safeguards Letter dated July 1, 2008. This revised letter 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 Chapter 14 to the Individuals with Disabilities Education Act (IDEA) regulatory revisions resulting from Rosa’s Law. There are no other changes to the current regulations in Chapter 14 or 711.

This revised Reevaluation Report (December 2022) replaces the July 2018 version and includes updated language. The updated language does not affect the process that local education agencies follow regarding the completion of the Reevaluation Report.

This revised Evaluation Report (July 2018) 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.

This annotated document is effective December 14, 2020. This revised annotated Summary of Academic Achievement and Functional Performance (with a footer indicating “December 2020”) includes the addition of an Act 26 data collection question and related guidance.

This form, effective beginning July 1, 2008, is to be used when the Local Education Agency (LEA) seeks to obtain consent from the parent to excuse required members of the IEP team from attending an IEP team meeting.

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.

This form, effective beginning July 1, 2008, is to be used when the Local Education Agency (LEA) seeks to obtain consent from the parent to excuse required members of the IEP team from attending an IEP team meeting.

This form, effective beginning July 1, 2008, is to be used when the Local Education Agency (LEA) seeks to obtain consent from the parent to excuse required members of the IEP team from attending an IEP team meeting.

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.

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.

This form, effective beginning July 1, 2008, is to be used when the Local Education Agency (LEA) seeks to obtain consent from the parent to excuse required members of the IEP team from attending an IEP team meeting.

This form is effective December 14, 2020. This revised Summary of Academic Achievement and Functional Performance (with a footer indicating “December 2020”) includes the addition of an Act 26 data collection question.

This revised Reevaluation Report (December 2022) replaces the July 2018 version and includes updated language. The updated language does not affect the process that local education agencies follow regarding the completion of the Reevaluation Report.

This revised Procedural Safeguards Letter (with a footer indicating “July 2018 Revisions”) replaces the current Procedural Safeguards Letter dated July 1, 2008. This revised letter 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 Chapter 14 to the Individuals with Disabilities Education Act (IDEA) regulatory revisions resulting from Rosa’s Law. There are no other changes to the current regulations in Chapter 14 or 711.

This form, effective beginning July 1, 2008, is to be used when the Local Education Agency (LEA) seeks to obtain consent from the parent to excuse required members of the IEP team from attending an IEP team meeting.

This form, effective beginning July 1, 2008, is to be used when the Local Education Agency (LEA) seeks to obtain consent from the parent to excuse required members of the IEP team from attending an IEP team meeting.

This form is effective December 14, 2020. This revised Summary of Academic Achievement and Functional Performance (with a footer indicating “December 2020”) includes the addition of an Act 26 data collection question.

This form, effective beginning July 1, 2008, is to be used when the Local Education Agency (LEA) seeks to obtain consent from the parent to excuse required members of the IEP team from attending an IEP team meeting.

This form is effective December 14, 2020. This revised Summary of Academic Achievement and Functional Performance (with a footer indicating “December 2020”) includes the addition of an Act 26 data collection question.

This revised Evaluation Report (July 2018) 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.

This revised Reevaluation Report (December 2022) replaces the July 2018 version and includes updated language. The updated language does not affect the process that local education agencies follow regarding the completion of the Reevaluation Report.

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.

This revised Procedural Safeguards Letter (with a footer indicating “July 2018 Revisions”) replaces the current Procedural Safeguards Letter dated July 1, 2008. This revised letter 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 Chapter 14 to the Individuals with Disabilities Education Act (IDEA) regulatory revisions resulting from Rosa’s Law. There are no other changes to the current regulations in Chapter 14 or 711.

This revised Evaluation Report (July 2018) 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.

This form is effective December 14, 2020. This revised Summary of Academic Achievement and Functional Performance (with a footer indicating “December 2020”) includes the addition of an Act 26 data collection question.

This revised Procedural Safeguards Letter (with a footer indicating “July 2018 Revisions”) replaces the current Procedural Safeguards Letter dated July 1, 2008. This revised letter 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 Chapter 14 to the Individuals with Disabilities Education Act (IDEA) regulatory revisions resulting from Rosa’s Law. There are no other changes to the current regulations in Chapter 14 or 711.

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.

This revised Reevaluation Report (December 2022) replaces the July 2018 version and includes updated language. The updated language does not affect the process that local education agencies follow regarding the completion of the Reevaluation Report.

This form, effective beginning July 1, 2008, is to be used when the Local Education Agency (LEA) seeks to obtain consent from the parent to excuse required members of the IEP team from attending an IEP team meeting.

This form, effective beginning July 1, 2008, is to be used when the Local Education Agency (LEA) seeks to obtain consent from the parent to excuse required members of the IEP team from attending an IEP team meeting.

This revised Procedural Safeguards Letter (with a footer indicating “July 2018 Revisions”) replaces the current Procedural Safeguards Letter dated July 1, 2008. This revised letter 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 Chapter 14 to the Individuals with Disabilities Education Act (IDEA) regulatory revisions resulting from Rosa’s Law. There are no other changes to the current regulations in Chapter 14 or 711.

This form is effective December 14, 2020. This revised Summary of Academic Achievement and Functional Performance (with a footer indicating “December 2020”) includes the addition of an Act 26 data collection question.

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.

The Communication Plan must be included in the IEP of any student who is deaf or hard of hearing. The Communication Plan form was revised July 2022. At that time changes were made in Sections l, lll, and IV. Sections have been reduced to Sections l and Section ll. Section l: Language and Communication Needs, includes a sign-in area for contributors, asks for data to support conclusions and includes a chart to address primary language and communication mode. Section lll has updated the language for assistive technology, devices, and services. Section lll requires the team to examine if the student has appropriate academic language and communication skills to participate in and access curriculum and instruction. Section lV, Full Range of Needs, has been made into a question thus requiring more discussion. Glossary terms have also been added, revised or deleted as appropriate. The revised plan has a footer reading October 14, 2022. Annotated version available

The Communication Plan must be included in the IEP of any student who is deaf or hard of hearing. The Communication Plan form was revised July 2022. At that time changes were made in Sections l, lll, and IV. Sections have been reduced to Sections l and Section ll. Section l: Language and Communication Needs, includes a sign-in area for contributors, asks for data to support conclusions and includes a chart to address primary language and communication mode. Section lll has updated the language for assistive technology, devices, and services. Section lll requires the team to examine if the student has appropriate academic language and communication skills to participate in and access curriculum and instruction. Section lV, Full Range of Needs, has been made into a question thus requiring more discussion. Glossary terms have also been added, revised or deleted as appropriate. The revised plan has a footer reading October 14, 2022. Annotated version available

The Communication Plan must be included in the IEP of any student who is deaf or hard of hearing. The Communication Plan form was revised July 2022. At that time changes were made in Sections l, lll, and IV. Sections have been reduced to Sections l and Section ll. Section l: Language and Communication Needs, includes a sign-in area for contributors, asks for data to support conclusions and includes a chart to address primary language and communication mode. Section lll has updated the language for assistive technology, devices, and services. Section lll requires the team to examine if the student has appropriate academic language and communication skills to participate in and access curriculum and instruction. Section lV, Full Range of Needs, has been made into a question thus requiring more discussion. Glossary terms have also been added, revised or deleted as appropriate. The revised plan has a footer reading October 14, 2022. Annotated version available

This annotated document describes the contents of the Parental Consent To Excuse Members from Attending the IEP Team Meeting form, which is used by the LEA to obtain consent from the parent to excuse required members of the IEP team from attending an IEP team meeting.

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.

The recent supplemental regulations to 34 CFR Part 300, effective August 2009, 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 August 2009, describes how to use the current NOREP/PWN to provide this notice to the parents.

The Communication Plan must be included in the IEP of any student who is deaf or hard of hearing. The Communication Plan form was revised July 2022. At that time changes were made in Sections l, lll, and IV. Sections have been reduced to Sections l and Section ll. Section l: Language and Communication Needs, includes a sign-in area for contributors, asks for data to support conclusions and includes a chart to address primary language and communication mode. Section lll has updated the language for assistive technology, devices, and services. Section lll requires the team to examine if the student has appropriate academic language and communication skills to participate in and access curriculum and instruction. Section lV, Full Range of Needs, has been made into a question thus requiring more discussion. Glossary terms have also been added, revised or deleted as appropriate. The revised plan has a footer reading October 14, 2022. Annotated version available

The Communication Plan must be included in the IEP of any student who is deaf or hard of hearing. The Communication Plan form was revised July 2022. At that time changes were made in Sections l, lll, and IV. Sections have been reduced to Sections l and Section ll. Section l: Language and Communication Needs, includes a sign-in area for contributors, asks for data to support conclusions and includes a chart to address primary language and communication mode. Section lll has updated the language for assistive technology, devices, and services. Section lll requires the team to examine if the student has appropriate academic language and communication skills to participate in and access curriculum and instruction. Section lV, Full Range of Needs, has been made into a question thus requiring more discussion. Glossary terms have also been added, revised or deleted as appropriate. The revised plan has a footer reading October 14, 2022. Annotated version available

Russian version of the letter of invitation for transition to the Preschool EI Program or to other community services. Invitation letters must be sent to the family, Preschool EI Program and other participants no later than 30 days before the scheduled transition meeting date, unless the parties all agree to meet within shorter timelines.

Nepali version of the letter of invitation for transition to the Preschool EI Program or to other community services. Invitation letters must be sent to the family, Preschool EI Program and other participants no later than 30 days before the scheduled transition meeting date, unless the parties all agree to meet within shorter timelines.

French version of the letter of invitation for transition to the Preschool EI Program or to other community services. Invitation letters must be sent to the family, Preschool EI Program and other participants no later than 30 days before the scheduled transition meeting date, unless the parties all agree to meet within shorter timelines.

Arabic version of the letter of invitation for transition to the Preschool EI Program or to other community services. Invitation letters must be sent to the family, Preschool EI Program and other participants no later than 30 days before the scheduled transition meeting date, unless the parties all agree to meet within shorter timelines.

Spanish version of the letter of invitation for transition to the Preschool EI Program or to other community services. Invitation letters must be sent to the family, Preschool EI Program and other participants no later than 30 days before the scheduled transition meeting date, unless the parties all agree to meet within shorter timelines.

Chinese version of the letter of invitation for transition to the Preschool EI Program or to other community services. Invitation letters must be sent to the family, Preschool EI Program and other participants no later than 30 days before the scheduled transition meeting date, unless the parties all agree to meet within shorter timelines.

Chinese version of the letter of invitation for transition to the Preschool EI Program or to other community services. Invitation letters must be sent to the family, Preschool EI Program and other participants no later than 30 days before the scheduled transition meeting date, unless the parties all agree to meet within shorter timelines.

Letters of invitation for transition to the Preschool EI Program or to other community services. Invitation letters ,Swahili version, must be sent to the family, Preschool EI Program and other participants no later than 30 days before the scheduled transition meeting date, unless the parties all agree to meet within shorter timelines.

Letters of invitation for transition to the Preschool EI Program or to other community services. Invitation letters , Malayalam version, must be sent to the family, Preschool EI Program, and other participants no later than 30 days before the scheduled transition meeting date, unless the parties all agree to meet within shorter timelines.

Letters of invitation for transition to the Preschool EI Program or to other community services. Invitation letters , Farsi version, must be sent to the family, Preschool EI Program, and other participants no later than 30 days before the scheduled transition meeting date, unless the parties all agree to meet within shorter timelines.

Letters of invitation for transition to the Preschool EI Program or to other community services. Invitation letters, Bengali version, must be sent to the family, Preschool EI Program, and other participants no later than 30 days before the scheduled transition meeting date, unless the parties all agree to meet within shorter timelines.

Letters of invitation for transition to the Preschool EI Program or to other community services. Invitation letters, Haitian Creole version, must be sent to the family, Preschool EI Program, and other participants no later than 30 days before the scheduled transition meeting date, unless the parties all agree to meet within shorter timelines.

Portuguese version of the letter of invitation for transition to the Preschool EI Program or to other community services. Invitation letters must be sent to the family, Preschool EI Program and other participants no later than 30 days before the scheduled transition meeting date, unless the parties all agree to meet within shorter timelines.

This Chinese version of the form used along with an Invitation to Participate in an IEP Meeting if there are team members who are invited to attend but the program would like to excuse their participation.

This Portuguese version of the form is used to invite team members to an IEP or other meeting.

This Portuguese version of the form used along with an Invitation to Participate in an IEP Meeting if there are team members who are invited to attend but the program would like to excuse their participation.

Russian Version of the Preschool Early Intervention Permission to Evaluate form. This form must be issued by the Local Education Agency to obtain written consent to conduct an initial evaluation.

This Russian version of the form is used to invite team members to an IEP or other meeting.

This Russian version of the form used along with an Invitation to Participate in an IEP Meeting if there are team members who are invited to attend but the program would like to excuse their participation.

This Nepali version of the form used along with an Invitation to Participate in an IEP Meeting if there are team members who are invited to attend but the program would like to excuse their participation.

This Nepali version of the form is used to invite team members to an IEP or other meeting.

This French version of the form used along with an Invitation to Participate in an IEP Meeting if there are team members who are invited to attend but the program would like to excuse their participation.

Arabic Version of the Preschool Early Intervention Permission to Evaluate form. This form must be issued by the Local Education Agency to obtain written consent to conduct an initial evaluation.

Chinese Version of the Preschool Early Intervention Permission to Evaluate form. This form must be issued by the Local Education Agency to obtain written consent to conduct an initial evaluation.