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 1-81 of 81
Transition to Community Letter  cover image

Transition to Community Letter

Effective Date:1/1/0001 12:00:00 AM
Transition meeting invitation letter for children and families anticipating transition to a community program or leaving early intervention. Form updated 05/09
Age:
Language:English
Summary of Academic Achievement and Functional Performance (Annotated) cover image

Summary of Academic Achievement and Functional Performance (Annotated)

Effective Date:12/14/2020 7:42:58 AM
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.
Age:School Age
Language:English
Summary of Academic Achievement and Functional Performance cover image

Summary of Academic Achievement and Functional Performance

Effective Date:12/14/2020 1:33:51 PM
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.
Age:School Age
Language:English
Special Education State Complaint Resolution Procedures cover image

Special Education State Complaint Resolution Procedures

Effective Date:2/29/2016 11:00:00 PM
This publication outlines the procedures that are followed when complainants allege that the rights of one or more students eligible for services under the IDEA, Chapters 14 or 711 in the State Board Regulations or corresponding federal statutes or regulations have been violated. The IDEA requires the Bureau of Special Education (BSE) to encourage local and less adversarial resolutions to issues. However, federal regulations are clear that resolution activities cannot bar the complaint investigation process. The purpose of these procedures is to: 1. Clearly articulate the process to be followed. 2. Serve as a reference guide and training document. 3. Ensure compliance with federal and state guidelines.
Age:School Age
Language:English
Service Coordination Checklist for Providing Information to Families about Medical Assistance cover image

Service Coordination Checklist for Providing Information to Families about Medical Assistance

Effective Date:9/14/2020 7:25:55 AM
This document provides guidance to Infant Toddler Early Intervention Service Coordinators on discussing enrollment in Pennsylvania’s Medical Assistance program with families.
Age:Infant/Toddler
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
Reevaluation Report  cover image

Reevaluation Report

Effective Date:7/1/2018 8:41:03 AM
This revised Reevaluation 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.
Age:School Age
Language:English
Procedural Safeguards Notice - Preschool Early Intervention  cover image

Procedural Safeguards Notice - Preschool Early Intervention

Effective Date:1/1/0001 12:00:00 AM
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.
Age:Preschool
Language:English
Procedural Safeguards Notice - Preschool Early Intervention cover image

Procedural Safeguards Notice - Preschool Early Intervention

Effective Date:12/1/2014 12:00:00 AM
The Procedural Safeguards Notice includes a full explanation of all the rights available to parents of a child in Preschool Early Intervention when their child has been referred for or is receiving Early Intervention services.
Age:Preschool
Language:English
Procedural Safeguards Notice  cover image

Procedural Safeguards Notice

Effective Date:7/1/2018 8:41:03 AM
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:English
Procedural Safeguards Letter - Preschool Early Intervention  cover image

Procedural Safeguards Letter - Preschool Early Intervention

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.
Age:Preschool
Language:English
Procedural Safeguards Letter – Early Intervention cover image

Procedural Safeguards Letter – Early Intervention

Effective Date:12/1/2014 12:00:00 AM
Letter to a parent on their rights and their child’s rights related to Early Intervention services.
Age:Preschool
Language:English
Procedural Safeguards Letter  cover image

Procedural Safeguards Letter

Effective Date:7/1/2018 8:41:03 AM
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.
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
Prior Written Notice for Reevaluation and Request for Consent Form - School Age cover image

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

Effective Date:3/29/2015 11:00:00 PM
This new form is effective beginning March 30, 2015 and 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. It contains the footer, “Revised January 2015.”
Age:School Age
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 Initial Evaluation and Request for Consent Form - School Age cover image

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

Effective Date:3/29/2015 11:00:00 PM
This new form is effective beginning March 30, 2015 and 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 the initial evaluation. This form replaces the Permission to Evaluate – Consent Form. It contains the footer, “Revised January 2015.”
Age:School Age
Language:English
Preschool to School Age Transition Considerations for Children who are Deaf, Hard of Hearing or Deaf-Blind cover image

Preschool to School Age Transition Considerations for Children who are Deaf, Hard of Hearing or Deaf-Blind

Effective Date:10/31/2015 11:00:00 PM
Preschool to School Age Transition Considerations for Children who are Deaf, Hard of Hearing or Deaf-Blind
Age:School Age
Language:English
Preschool Early Intervention Evaluation Report – Annotated cover image

Preschool Early Intervention Evaluation Report – Annotated

Effective Date:12/1/2018 12:00:00 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. This annotated form provides guidance to parents and early intervention staff completing the evaluation report. It is not intended as an exclusive manner for complying with state and/or federal special education statutes and regulations.
Age:Preschool
Language:English
Preschool Early Intervention Evaluation Report  cover image

Preschool Early Intervention Evaluation Report

Effective Date:12/1/2018 12:00:00 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:English
Permission to Reevaluate (Annotated) - Preschool Early Intervention  cover image

Permission to Reevaluate (Annotated) - Preschool Early Intervention

Effective Date:1/1/0001 12:00:00 AM
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.
Age:Preschool
Language:English
Permission to Re-evaluate - Oral Request Form (Annotated) cover image

Permission to Re-evaluate - Oral Request Form (Annotated)

Effective Date:6/8/2021 11:55:35 AM
This annotated document describes the contents of the Permission to Reevaluate - Oral Request Form, which is provided to the parent by the LEA upon a parent’s oral request for a reevaluation. This form provides the means of getting the parental request in writing.
Age:School Age
Language:English
Permission to Re-evaluate - Oral Request Form cover image

Permission to Re-evaluate - Oral Request Form

Effective Date:6/8/2021 11:53:21 AM
This form is effective beginning June 8, 2021. This document must be issued by the Local Education Agency in response to a parent’s oral request for a reevaluation within 10 calendar days of the oral request. Annotated version available
Age:School Age
Language:English
PERMISSION TO REEVALUATE  - Preschool Early Intervention  cover image

PERMISSION TO REEVALUATE - Preschool Early Intervention

Effective Date:1/1/0001 12:00:00 AM
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.
Age:Preschool
Language:English
Permission to Evaluate (Annotated) - Preschool Early Intervention cover image

Permission to Evaluate (Annotated) - Preschool Early Intervention

Effective Date:1/1/0001 12:00:00 AM
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.
Age:Preschool
Language:English
PERMISSION TO EVALUATE - Preschool Early Intervention cover image

PERMISSION TO EVALUATE - Preschool Early Intervention

Effective Date:1/1/0001 12:00:00 AM
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.
Age:Preschool
Language:English
PERMISSION TO EVALUATE – ORAL REQUEST FORM (ANNOTATED) cover image

PERMISSION TO EVALUATE – ORAL REQUEST FORM (ANNOTATED)

Effective Date:6/8/2021 11:51:17 AM
This annotated document describes the contents of the Permission to Evaluate - Oral Request Form, which is provided to the parent by the LEA upon a parent’s oral request for an evaluation. This form provides the means of documenting the parental request in writing.
Age:School Age
Language:English
PERMISSION TO EVALUATE – ORAL REQUEST FORM cover image

PERMISSION TO EVALUATE – ORAL REQUEST FORM

Effective Date:6/8/2021 11:48:42 AM
This form is effective beginning June 8, 2021. This document must be issued by the Local Education Agency in response to a parent's oral request for an evaluation within 10 calendar days of the oral request.
Age:School Age
Language:English
Pennsylvania Medical Assistance Billing Parental Notice - Annotated cover image

Pennsylvania Medical Assistance Billing Parental Notice - Annotated

Effective Date:11/1/2017 12:00:00 AM
This is an annotated version of the Medical Assistance Billing Parental Notice form which provides notice to parents on giving consent for the Local Educational Agency (LEA) to access reimbursement from Medical Assistance for special education services. This annotation offers guidance to Early Intervention staff. It is not intended as an exclusive manner for complying with state and/or federal special education statutes and regulations.
Age:Infant/Toddler,Preschool
Language:English
Pennsylvania Medical Assistance Billing Parental Notice  cover image

Pennsylvania Medical Assistance Billing Parental Notice

Effective Date:11/1/2017 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. This 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:Preschool,Infant/Toddler
Language:English
Pennsylvania Medical Assistance Billing Parental Consent - Annotated cover image

Pennsylvania Medical Assistance Billing Parental Consent - Annotated

Effective Date:10/1/2016 12:00:00 AM
This is an annotated version of the Medical Assistance Billing Parental Consent form. This annotation provides guidance for understanding the options outlined in this form.
Age:Infant/Toddler,Preschool
Language:English
Pennsylvania Medical Assistance Billing Parental Consent cover image

Pennsylvania Medical Assistance Billing Parental Consent

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
Pennsylvania Early Intervention Communication Plan cover image

Pennsylvania Early Intervention Communication Plan

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
Parental Consent to Excuse Members from Attending the Individualized Education Program (IEP) Team Meeting (Annotated) - School Age cover image

Parental Consent to Excuse Members from Attending the Individualized Education Program (IEP) Team Meeting (Annotated) - School Age

Effective Date:10/8/2008 11:00:00 PM
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.
Age:School Age
Language:English
Parental Consent to Excuse Members from Attending the IEP Team Meeting (Annotated) - Preschool Early Intervention   cover image

Parental Consent to Excuse Members from Attending the IEP Team Meeting (Annotated) - Preschool Early Intervention

Effective Date:1/1/0001 12:00:00 AM
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.
Age:Preschool
Language:English
PARENTAL CONSENT TO EXCUSE MEMBERS FROM ATTENDING THE IEP TEAM MEETING - School Age cover image

PARENTAL CONSENT TO EXCUSE MEMBERS FROM ATTENDING THE IEP TEAM MEETING - School Age

Effective Date:6/30/2008 11:00:00 PM
This form is effective beginning July 1, 2008 and reflects new provisions of revised Chapters 14 and 711. This new Invitation (with a footer indicating "July 2008 Revisions") replaces the current Invitation. This Invitation no longer contains the request for parental consent to excuse members of the IEP team from attending the IEP team meeting. This request now is made with a separate form, "Parental Consent to Excuse Members from Attending the IEP Team Meeting."
Age:School Age
Language:English
PARENTAL CONSENT TO EXCUSE MEMBERS FROM ATTENDING THE IEP TEAM MEETING - Preschool Early Intervention  cover image

PARENTAL CONSENT TO EXCUSE MEMBERS FROM ATTENDING THE IEP TEAM MEETING - Preschool Early Intervention

Effective Date:1/1/0001 12:00:00 AM
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.
Age:Preschool
Language:English
Parent Rights Agreement - Annotated cover image

Parent Rights Agreement - Annotated

Effective Date:5/16/2018 12:00:00 AM
This is an annotated version of the Parent Rights Agreement that provides guidance to parents and Early Intervention staff for understanding parent and child’s rights during the Early Intervention process.
Age:Infant/Toddler
Language:English
Parent Rights Agreement cover image

Parent Rights Agreement

Effective Date:11/26/2014 12:00:00 AM
This form summarizes the parent and child’s rights during the Early Intervention process.
Age:Infant/Toddler
Language:English
Notice Of Your Child’s Transition To School Age Meeting - Annotated  cover image

Notice Of Your Child’s Transition To School Age Meeting - Annotated

Effective Date:1/1/0001 12:00:00 AM
his form is effective beginning March 2014. The Preschool Early Intervention program is responsible for sending this form on or before February 1st to the parents of all children approaching the age of kindergarten or 1st grade. 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 Your Child’s Transition To School Age Meeting  cover image

Notice Of Your Child’s Transition To School Age Meeting

Effective Date:1/1/0001 12:00:00 AM
This form is effective beginning March 2014. The Preschool Early Intervention program is responsible for sending this form on or before February 1st to the parents of all children approaching the age of kindergarten or 1st grade.
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
Notice of Recommended Educational Placement/Prior Written Notice (NOREP/PWN) (Annotated) - School Age cover image

Notice of Recommended Educational Placement/Prior Written Notice (NOREP/PWN) (Annotated) - School Age

Effective Date:11/6/2014 11:00:00 PM
This annotated NOREP/PWN form provides explanation for the document that LEAs may choose to communicate to parents the recommended educational program for their child and other actions taken by the LEA. This revised annotated NOREP/PWN includes additional resources for parents on page 6. The revised form contains the footer “October 2014.”
Age:School Age
Language:English
NOTICE OF RECOMMENDED EDUCATIONAL PLACEMENT/PRIOR WRITTEN NOTICE (NOREP/PWN) - School Age  cover image

NOTICE OF RECOMMENDED EDUCATIONAL PLACEMENT/PRIOR WRITTEN NOTICE (NOREP/PWN) - School Age

Effective Date:2/10/2011 11:00:00 PM
This NOREP/PWN form provides a format that LEAs may choose to provide to parents the recommended educational program for their child and other actions taken by the LEA. This revised NOREP/PWN includes additional resources for parents on page 4. The revised form contains the footer "February 11, 2011 Revisions.”
Age:School Age
Language:English
Notice of Recommended Educational Placement/Prior Written Notice (NOREP/PWN) – Preschool Early Intervention Annotated cover image

Notice of Recommended Educational Placement/Prior Written Notice (NOREP/PWN) – Preschool Early Intervention Annotated

Effective Date:12/1/2019 8:09:25 AM
This is an annotated version of the Notice of Recommended Educational Placement (NOREP). It provides guidance to preschool Early Intervention staff on using and explaining the NOREP to families. It also provide additional information on the special education process.
Age:Preschool
Language:English
NOTICE OF RECOMMENDED EDUCATIONAL PLACEMENT/PRIOR WRITTEN NOTICE (NOREP/PWN) - Preschool Early Intervention cover image

NOTICE OF RECOMMENDED EDUCATIONAL PLACEMENT/PRIOR WRITTEN NOTICE (NOREP/PWN) - Preschool Early Intervention

Effective Date:12/1/2019 11:40:58 AM
This form summarizes recommendations for a child’s preschool educational program and other actions proposed by the Preschool Early Intervention program. The form also includes state and local resources that provide additional information on the special education process.
Age:Preschool
Language:English
Notice Of Options For Your Child’s Transition - annotated cover image

Notice Of Options For Your Child’s Transition - annotated

Effective Date:1/1/0001 12:00:00 AM
This form is effective beginning March 2014. The Preschool Early Intervention program is responsible for sending this form on or before February 1st to the parents of all children approaching the age of kindergarten or 1st grade.
Age:
Language:English
Notice Of Options For Your Child’s Transition  cover image

Notice Of Options For Your Child’s Transition

Effective Date:1/1/0001 12:00:00 AM
Transition from Preschool Early Intervention to School Age Program – The Preschool Early Intervention program should include this form as an attachment to the Notice Of Your Child’s Transition to School Age Meeting. 10/2009
Age:
Language:English
Mediation Request Form - Preschool Early Intervention  cover image

Mediation Request Form - Preschool Early Intervention

Effective Date:1/1/0001 12:00:00 AM
Mediation Request Form is effective beginning July 2008. This new form can also be found in Appendix B of the Procedural Safeguards Notice which can be downloaded from the Preschool EI Forms page on the PaTTAN website.
Age:Preschool
Language:English
INVITATION TO PARTICIPATE IN THE IEP TEAM MEETING OR OTHER MEETING (Annotated) - School Age  cover image

INVITATION TO PARTICIPATE IN THE IEP TEAM MEETING OR OTHER MEETING (Annotated) - School Age

Effective Date:6/29/2015 11:00:00 PM
This revised annotated form describes the new Invitation to Participate in the IEP Team Meeting or Other Meeting(with footer indicating “May 2015 Revisions”), which adds supplementary purposes for an IEP team meeting, removes the requirement to use two separate Invitation to Participate in the IEP Team Meeting or Other Meeting forms for transition planning/services, and supplements the explanations for transition planning and services, including a statement that the local education agency (LEA) will invite the student, if age 14 or above. This form is effective beginning June 30, 2015.
Age:School Age
Language:English
Invitation to Participate in the IEP Team Meeting or Other Meeting (Annotated) - Preschool Early Intervention  cover image

Invitation to Participate in the IEP Team Meeting or Other Meeting (Annotated) - Preschool Early Intervention

Effective Date:1/1/0001 12:00:00 AM
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.
Age:Preschool
Language:English
INVITATION TO PARTICIPATE IN THE IEP TEAM MEETING OR OTHER MEETING - School Age cover image

INVITATION TO PARTICIPATE IN THE IEP TEAM MEETING OR OTHER MEETING - School Age

Effective Date:6/29/2015 11:00:00 PM
Revised May 2015 – This new Invitation to Participate in the IEP Team Meeting or Other Meeting (with footer indicating “May 2015 Revisions”) replaces the current Invitation. This revised form adds supplementary purposes for an IEP team meeting, removes the requirement to use two separate Invitation to Participate in the IEP Team Meeting or Other Meeting forms for transition planning/services, and supplements the explanations for transition planning and services, including a statement that the local education agency (LEA) will invite the student, if age 14 or above. This form is effective beginning June 30, 2015.
Age:School Age
Language:English
INVITATION TO PARTICIPATE IN THE IEP TEAM MEETING OR OTHER MEETING – Preschool Early Intervention  cover image

INVITATION TO PARTICIPATE IN THE IEP TEAM MEETING OR OTHER MEETING – Preschool Early Intervention

Effective Date:1/1/0001 12:00:00 AM
This form is effective beginning March 2014. This form is used to invite team members to an IEP or other meeting.
Age:Preschool
Language:English
Invitation to Participate in a Transition Meeting cover image

Invitation to Participate in a Transition Meeting

Effective Date:1/1/0001 12:00:00 AM
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.
Age:Infant/Toddler,Preschool
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
INTENT TO REGISTER –First Grade Eligible (Age of Beginners)  cover image

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

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.
Age:School Age,Preschool
Language:English
INTENT TO REGISTER – Kindergarten Age Eligible - Annotated  cover image

INTENT TO REGISTER – Kindergarten Age Eligible - 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:Preschool
Language:English
INTENT TO REGISTER – Kindergarten Age Eligible  cover image

INTENT TO REGISTER – Kindergarten Age Eligible

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.
Age:Preschool
Language:English
Infant Toddler Early Intervention Evaluation Report - Annotated  cover image

Infant Toddler Early Intervention Evaluation Report - Annotated

Effective Date:12/1/2018 12:00:00 AM
Infant Toddler 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. This annotated form provides guidance to parents and early intervention staff completing the evaluation report. It is not intended as an exclusive manner for complying with state and/or federal special education statutes and regulations.
Age:Infant/Toddler
Language:English
Infant Toddler Early Intervention Evaluation Report  cover image

Infant Toddler Early Intervention Evaluation Report

Effective Date:12/1/2018 12:00:00 AM
Infant Toddler 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:Infant/Toddler
Language:English
Individualized Family Service Plan/Individualized Education Program (IFSP/IEP) - Early Intervention cover image

Individualized Family Service Plan/Individualized Education Program (IFSP/IEP) - Early Intervention

Effective Date:12/1/2018 12:00:00 AM
Infant Toddler and Preschool Early Intervention plan document for use as of December 2018. The IFSP and IEP are plans that identify services and supports for children and families involved in Early Intervention. The IFSP and IEP consider the strengths of the child; concerns of the parent/guardian and most recent evaluation results so that family members and early education programs are actively engaged in promoting the child’s learning and development.
Age:Infant/Toddler,Preschool
Language:English
Individualized Family Service Plan (IFSP) - Early Intervention Annotated cover image

Individualized Family Service Plan (IFSP) - Early Intervention Annotated

Effective Date:12/1/2018 1:47:01 PM
Infant Toddler Early Intervention plan document for use as of December 2018. The IFSP and IEP are plans that identify services and supports for children and families involved in Early Intervention. The IFSP and IEP consider the strengths of the child; concerns of the parent/guardian and most recent evaluation results so that family members and early education programs are actively engaged in promoting the child’s learning and development. This annotated form provides guidance to parents and early intervention staff completing the evaluation report. It is not intended as an exclusive manner for complying with state and/or federal special education statutes and regulations.
Age:Infant/Toddler
Language:English
Individualized Education Program (IEP) - Early Intervention Annotated cover image

Individualized Education Program (IEP) - Early Intervention Annotated

Effective Date:
Preschool Early Intervention plan document for use as of December 2018. The IEP is a plan that identify services and supports for children and families involved in Early Intervention. The IEP considers the strengths of the child; concerns of the parent/guardian and most recent evaluation results so that family members and early education programs are actively engaged in promoting the child’s learning and development. This annotated form provides guidance to parents and early intervention staff completing the evaluation report. It is not intended as an exclusive manner for complying with state and/or federal special education statutes and regulations.
Age:Preschool
Language:English
Individualized Education Program (IEP) cover image

Individualized Education Program (IEP)

Effective Date:2/1/2020 8:41:03 AM
Revised IEP February 1, 2020 – This revised form (with footer February 1, 2020) provides changes to section IV (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
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
Evaluation Report  cover image

Evaluation Report

Effective Date:7/1/2018 8:41:03 AM
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.
Age:School Age
Language:English
Early Intervention Session Note Form  cover image

Early Intervention Session Note Form

Effective Date:3/1/2013 2:23:53 PM
This standardized session note form is to be used by all Infant/Toddler Early Intervention programs. The session note form documents the provision of services and supports, assures communication with families/caregivers and provides a mechanism to monitor the quality of services. Updated March 2013.
Age:Infant/Toddler
Language:English
Due Process Complaint Notice - Preschool Early Intervention  cover image

Due Process Complaint Notice - Preschool Early Intervention

Effective Date:1/1/0001 12:00:00 AM
This Due Process Complaint Notice is effective beginning July 2014. This new form can also be found in Appendix B of the Procedural Safeguards Notice which can be downloaded from the Preschool EI Forms page on the PaTTAN website.
Age:Preschool
Language:English
Complaint Resolution Process - Early Intervention  cover image

Complaint Resolution Process - Early Intervention

Effective Date:1/1/0001 12:00:00 AM
The Formal Complaint Form/Contact Information for (Infant Toddler and Preschool) is a form that parents can complete to request a formal complaint through the Bureau of Early Intervention Services.
Age:Infant/Toddler,Preschool
Language:English
Communication Plan for a Child Who Is Deaf or Hard of Hearing (Annotated) - School Age cover image

Communication Plan for a Child Who Is Deaf or Hard of Hearing (Annotated) - School Age

Effective Date:10/8/2008 11:00:00 PM
The primary purpose of the Communication Plan is to establish discussion among all IEP team members who review the student’s needs based on communication skills and access. The Communication Plan should be the starting point for the IEP, and the results of this discussion should be used to identify the student’s present educational levels as well as to complete other sections of the IEP. The Annotated Communication Plan was revised in December 2010. Changes have been made to the following areas: annotation added for Section I, question 5; to Section III concerning the definition of qualified interpreters, and to the glossary to include definitions of qualified interpreters and communication modes and assistive technology devices and services for students who are deafblind. The revised version has December 2010 in the footer.
Age:School Age
Language:English
COMMUNICATION PLAN - School Age  cover image

COMMUNICATION PLAN - School Age

Effective Date:7/1/2008 11:00:00 PM
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 December 2010. At that time additions were made in Sections I and III of the plan to include communication needs and assistive technology devices and services for students who are deafblind. The revised plan has a footer reading December 2010. Annotated version available
Age:School Age
Language:English
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
Authorization to Release Information for Infants/Toddlers with Hearing Concerns cover image

Authorization to Release Information for Infants/Toddlers with Hearing Concerns

Effective Date:5/20/2020 2:29:16 PM
A standard release form that will allow Early Intervention and the Department of Health to exchange information with a family of a child who is deaf or hard of hearing.
Age:Infant/Toddler
Language:English
Authorization to Release Information for Children in Early Intervention cover image

Authorization to Release Information for Children in Early Intervention

Effective Date:5/28/2018 12:00:00 AM
This standard release form is used to obtain permission to share information with community agencies who are currently involved with local Early Intervention programs.
Age:Infant/Toddler,Preschool
Language:English
Annotated Individualized Education Program with COVID-19 Guidance cover image

Annotated Individualized Education Program with COVID-19 Guidance

Effective Date:12/14/2020 1:41:40 PM
This annotated document is effective December 14, 2020. It provides guidance on the development of the Individual Education Program; guidance related to school closures associated with COVID-19; and guidance pertaining to the October 2020 revision to Act 26 questions associated with postsecondary transition. Note: The annotated IEP was reformatted as of June 14, 2021. Features were added to enhance navigation, search capabilities, and previewing of sections. The content has not changed.
Age:School Age
Language:English
Annotated Individualized Education Plan cover image

Annotated Individualized Education Plan

Effective Date:12/14/2020 1:55:32 PM
This annotated document is effective December 14, 2020. It provides guidance on the development of the Individual Education Program; guidance related to school closures associated with COVID-19; and guidance pertaining to the October 2020 revision to Act 26 questions associated with postsecondary transition.
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
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
AGREEMENT TO WAIVE REEVALUATION - School Age cover image

AGREEMENT TO WAIVE REEVALUATION - School Age

Effective Date:6/30/2008 11:00:00 PM
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.
Age:School Age
Language:English
Act 26 Questions and Answers cover image

Act 26 Questions and Answers

Effective Date:1/1/0001 12:00:00 AM
Act 26 Questions and Answers
Age:
Language:English
A Family’s Introduction to Early Intervention in Pennsylvania cover image

A Family’s Introduction to Early Intervention in Pennsylvania

Effective Date:7/13/2020 2:00:56 PM
This booklet explains how to request Early Intervention services; eligibility criteria; rights and responsibilities; individualized family service planning for ages birth to three; and individualized education planning for ages three to school age. For copies, please contact connecthelp@tiu11.org.
Age:Infant/Toddler,Preschool
Language:English