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:11/16/2022 12:00:00 AM
Preschool Early Intervention Evaluation Report, Portuguese 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:Preschool
Language:Portuguese
Effective Date:11/16/2022 12:00:00 AM
Preschool 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:Preschool
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:Preschool
Language:Spanish
Effective Date:12/30/2018 9:30:42 AM
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:Preschool
Language:Vietnamese
Effective Date:12/1/2018 9:29:33 AM
Early Intervention Evaluation Report, Khmer version, 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:Preschool
Language:Khmer
Effective Date:10/1/2023 12:00:00 AM
Early Intervention Evaluation Report, Farsi version, 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:Preschool
Language:Farsi
Effective Date:12/1/2018 12:00:00 AM
Early Intervention Evaluation Report, Malayalam version, 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:Preschool
Language:Malayalam
Effective Date:12/1/2018 12:00:00 AM
Early Intervention Evaluation Report, Swahili version, 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:Preschool
Language:Swahili
Effective Date:11/30/2014 11:00:00 PM
Letter to a parent on their rights and their child’s rights related to early intervention services Khmer version.
Age:Preschool
Language:Khmer
Effective Date:11/30/2014 11:00:00 PM
Letter to a parent on their rights and their child’s rights related to early intervention services Russian version.
Age:Preschool
Language:Russian