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 and State Complaint Resolution Procedures on PDE’s Special Education Dispute Resolution page. This webpage also contains the State Complaint Form translated into other languages.

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.


IEP in Braille

Download the Nemeth format ⏷

Download the UEB format ⏷

Results 1-100 of 498
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 (Vietnamese) cover image

Summary of Academic Achievement and Functional Performance (Vietnamese)

Effective Date:7/1/2008 12:00:00 AM
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:Vietnamese
Summary of Academic Achievement and Functional Performance (Urdu) cover image

Summary of Academic Achievement and Functional Performance (Urdu)

Effective Date:7/1/2008 12:00:00 AM
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:Urdu
Summary of Academic Achievement and Functional Performance (Ukranian) cover image

Summary of Academic Achievement and Functional Performance (Ukranian)

Effective Date:7/1/2008 12:00:00 AM
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:Ukranian
Summary of Academic Achievement and Functional Performance (Spanish) cover image

Summary of Academic Achievement and Functional Performance (Spanish)

Effective Date:7/1/2008 12:00:00 AM
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:Spanish
Summary of Academic Achievement and Functional Performance (Russian) cover image

Summary of Academic Achievement and Functional Performance (Russian)

Effective Date:7/1/2008 12:00:00 AM
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:Russian
Summary of Academic Achievement and Functional Performance (Italian) cover image

Summary of Academic Achievement and Functional Performance (Italian)

Effective Date:7/1/2008 12:00:00 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:Italian
Summary of Academic Achievement and Functional Performance (Annotated) cover image

Summary of Academic Achievement and Functional Performance (Annotated)

Effective Date:12/14/2020 8:42:58 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 2:33:51 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
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
Request for Consent for a Reevaluation (Vietnamese) cover image

Request for Consent for a Reevaluation (Vietnamese)

Effective Date:11/1/2023 8:30:25 AM
The Prior Written Notice for a Reevaluation and Request for Consent form has been separated into two forms, the Prior Written Notice for a Reevaluation form and the Request for Consent for a Reevaluation form. The form was separated into two forms to ensure LEAs provide parents with prior written notice and obtain parent consent at proper times during the reevaluation process in accordance with 34 CFR 300.300 and 300.503.
Age:School Age
Language:Vietnamese
Request for Consent for a Reevaluation (Swahili) cover image

Request for Consent for a Reevaluation (Swahili)

Effective Date:11/1/2023 8:24:13 AM
The Prior Written Notice for a Reevaluation and Request for Consent form has been separated into two forms, the Prior Written Notice for a Reevaluation form and the Request for Consent for a Reevaluation form. The form was separated into two forms to ensure LEAs provide parents with prior written notice and obtain parent consent at proper times during the reevaluation process in accordance with 34 CFR 300.300 and 300.503.
Age:School Age
Language:Swahili
Request for Consent for a Reevaluation (Spanish) cover image

Request for Consent for a Reevaluation (Spanish)

Effective Date:11/1/2023 8:18:11 AM
The Prior Written Notice for a Reevaluation and Request for Consent form has been separated into two forms, the Prior Written Notice for a Reevaluation form and the Request for Consent for a Reevaluation form. The form was separated into two forms to ensure LEAs provide parents with prior written notice and obtain parent consent at proper times during the reevaluation process in accordance with 34 CFR 300.300 and 300.503.
Age:School Age
Language:Spanish
Request for Consent for a Reevaluation (Russian) cover image

Request for Consent for a Reevaluation (Russian)

Effective Date:11/1/2023 8:13:48 AM
The Prior Written Notice for a Reevaluation and Request for Consent form has been separated into two forms, the Prior Written Notice for a Reevaluation form and the Request for Consent for a Reevaluation form. The form was separated into two forms to ensure LEAs provide parents with prior written notice and obtain parent consent at proper times during the reevaluation process in accordance with 34 CFR 300.300 and 300.503.
Age:School Age
Language:Russian
Request for Consent for a Reevaluation (Portuguese) cover image

Request for Consent for a Reevaluation (Portuguese)

Effective Date:11/1/2023 8:08:59 AM
The Prior Written Notice for a Reevaluation and Request for Consent form has been separated into two forms, the Prior Written Notice for a Reevaluation form and the Request for Consent for a Reevaluation form. The form was separated into two forms to ensure LEAs provide parents with prior written notice and obtain parent consent at proper times during the reevaluation process in accordance with 34 CFR 300.300 and 300.503.
Age:School Age
Language:Portuguese
Request for Consent for a Reevaluation (Nepali) cover image

Request for Consent for a Reevaluation (Nepali)

Effective Date:11/1/2023 7:58:27 AM
The Prior Written Notice for a Reevaluation and Request for Consent form has been separated into two forms, the Prior Written Notice for a Reevaluation form and the Request for Consent for a Reevaluation form. The form was separated into two forms to ensure LEAs provide parents with prior written notice and obtain parent consent at proper times during the reevaluation process in accordance with 34 CFR 300.300 and 300.503.
Age:School Age
Language:Nepali
Request for Consent for a Reevaluation (French) cover image

Request for Consent for a Reevaluation (French)

Effective Date:11/1/2023 8:42:04 AM
The Prior Written Notice for a Reevaluation and Request for Consent form has been separated into two forms, the Prior Written Notice for a Reevaluation form and the Request for Consent for a Reevaluation form. The form was separated into two forms to ensure LEAs provide parents with prior written notice and obtain parent consent at proper times during the reevaluation process in accordance with 34 CFR 300.300 and 300.503.
Age:School Age
Language:French
Request for Consent for a Reevaluation (Chinese) cover image

Request for Consent for a Reevaluation (Chinese)

Effective Date:11/1/2023 8:42:04 AM
The Prior Written Notice for a Reevaluation and Request for Consent form has been separated into two forms, the Prior Written Notice for a Reevaluation form and the Request for Consent for a Reevaluation form. The form was separated into two forms to ensure LEAs provide parents with prior written notice and obtain parent consent at proper times during the reevaluation process in accordance with 34 CFR 300.300 and 300.503.
Age:School Age
Language:Chinese
Request for Consent for a Reevaluation (Bengali) cover image

Request for Consent for a Reevaluation (Bengali)

Effective Date:11/1/2023 8:42:04 AM
The Prior Written Notice for a Reevaluation and Request for Consent form has been separated into two forms, the Prior Written Notice for a Reevaluation form and the Request for Consent for a Reevaluation form. The form was separated into two forms to ensure LEAs provide parents with prior written notice and obtain parent consent at proper times during the reevaluation process in accordance with 34 CFR 300.300 and 300.503.
Age:School Age
Language:Bengali
Request for Consent for a Reevaluation (Arabic) cover image

Request for Consent for a Reevaluation (Arabic)

Effective Date:11/1/2023 8:42:04 AM
The Prior Written Notice for a Reevaluation and Request for Consent form has been separated into two forms, the Prior Written Notice for a Reevaluation form and the Request for Consent for a Reevaluation form. The form was separated into two forms to ensure LEAs provide parents with prior written notice and obtain parent consent at proper times during the reevaluation process in accordance with 34 CFR 300.300 and 300.503.
Age:School Age
Language:Arabic
Request for Consent for a Reevaluation (ANNOTATED) cover image

Request for Consent for a Reevaluation (ANNOTATED)

Effective Date:11/1/2023 12:00:00 AM
The Prior Written Notice for a Reevaluation and Request for Consent form has been separated into two forms, the Prior Written Notice for a Reevaluation form and the Request for Consent for a Reevaluation form. The form was separated into two forms to ensure LEAs provide parents with prior written notice and obtain parent consent at proper times during the reevaluation process in accordance with 34 CFR 300.300 and 300.503.
Age:School Age
Language:English
Request for Consent for a Reevaluation cover image

Request for Consent for a Reevaluation

Effective Date:11/1/2023 12:00:00 AM
The Prior Written Notice for a Reevaluation and Request for Consent form has been separated into two forms, the Prior Written Notice for a Reevaluation form and the Request for Consent for a Reevaluation form. The form was separated into two forms to ensure LEAs provide parents with prior written notice and obtain parent consent at proper times during the reevaluation process in accordance with 34 CFR 300.300 and 300.503.
Age:School Age
Language:English
Reevaluation Report (Urdu) cover image

Reevaluation Report (Urdu)

Effective Date:7/1/2008 12:00:00 AM
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.
Age:School Age
Language:Urdu
Reevaluation Report (Ukranian) cover image

Reevaluation Report (Ukranian)

Effective Date:7/1/2008 12:00:00 AM
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.
Age:School Age
Language:Ukranian
Reevaluation Report (Russian) cover image

Reevaluation Report (Russian)

Effective Date:7/1/2008 12:00:00 AM
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.
Age:School Age
Language:Russian
Reevaluation Report (Italian) cover image

Reevaluation Report (Italian)

Effective Date:7/1/2008 12:00:00 AM
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.
Age:School Age
Language:Italian
Reevaluation Report (Hebrew) cover image

Reevaluation Report (Hebrew)

Effective Date:7/1/2018 8:46:04 AM
גיל בית הספר 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:Hebrew
Reevaluation Report (Annotated) (Spanish) cover image

Reevaluation Report (Annotated) (Spanish)

Effective Date:12/2/2016 12:00:00 AM
This annotated form describes the contents of the Reevaluation Report and includes updated language.
Age:School Age
Language:Spanish
Reevaluation Report (Annotated) - School Age cover image

Reevaluation Report (Annotated) - School Age

Effective Date:12/1/2022 12:00:00 AM
This annotated form describes the contents of the Reevaluation Report and includes updated language.
Age:School Age
Language:English
REEVALUATION REPORT - School Age  cover image

REEVALUATION REPORT - School Age

Effective Date:12/1/2022 12:00:00 AM
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.
Age:School Age
Language:English
Procedural Safeguards Notice Preschool Early Intervention (Portuguese) cover image

Procedural Safeguards Notice Preschool Early Intervention (Portuguese)

Effective Date:12/1/2014 2:14:04 PM
This is the Portuguese version of the Procedural Safeguards Notice that 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:Portuguese
Procedural Safeguards Notice (Vietnamese) cover image

Procedural Safeguards Notice (Vietnamese)

Effective Date:4/28/2025 12:14:07 PM
The Procedural Safeguards Notice includes a full explanation of rights available to parents of a school age child with a disability 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 updated contact information and the Bureau of Special Education Complaint Information Packet and Form. Effective Date: April 28, 2025 Age: School Age Language: Vietnamese
Age:School Age
Language:Vietnamese
Procedural Safeguards Notice (Uzbek) cover image

Procedural Safeguards Notice (Uzbek)

Effective Date:7/1/2018 12:00:00 AM
The Procedural Safeguards Notice includes a full explanation of rights available to parents of a school age child with a disability 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 updated contact information and the Bureau of Special Education Complaint Information Packet and Form.
Age:School Age
Language:Uzbek
Procedural Safeguards Notice (Urdu) cover image

Procedural Safeguards Notice (Urdu)

Effective Date:4/28/2025 12:13:17 PM
The Procedural Safeguards Notice includes a full explanation of rights available to parents of a school age child with a disability 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 updated contact information and the Bureau of Special Education Complaint Information Packet and Form. Effective Date: April 28, 2025 Age: School Age Language: Urdu
Age:School Age
Language:Urdu
Procedural Safeguards Notice (Ukranian) cover image

Procedural Safeguards Notice (Ukranian)

Effective Date:4/28/2025 11:51:36 AM
The Procedural Safeguards Notice includes a full explanation of rights available to parents of a school age child with a disability 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 updated contact information and the Bureau of Special Education Complaint Information Packet and Form.
Age:School Age
Language:Ukranian
Procedural Safeguards Notice (Tagalog/Filapeno) cover image

Procedural Safeguards Notice (Tagalog/Filapeno)

Effective Date:7/1/2018 12:00:00 AM
The Procedural Safeguards Notice includes a full explanation of rights available to parents of a school age child with a disability 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 updated contact information and the Bureau of Special Education Complaint Information Packet and Form.
Age:School Age
Language:Tagalog/Filapeno
Procedural Safeguards Notice (Swahili) cover image

Procedural Safeguards Notice (Swahili)

Effective Date:4/28/2025 11:52:38 AM
The Procedural Safeguards Notice includes a full explanation of rights available to parents of a school age child with a disability 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 updated contact information and the Bureau of Special Education Complaint Information Packet and Form.
Age:School Age
Language:Swahili
Procedural Safeguards Notice (Spanish) cover image

Procedural Safeguards Notice (Spanish)

Effective Date:4/28/2025 12:11:47 PM
The Procedural Safeguards Notice includes a full explanation of rights available to parents of a school age child with a disability 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 updated contact information and the Bureau of Special Education Complaint Information Packet and Form. Effective Date: April 28, 2025 Age: School Age Language: Spanish
Age:School Age
Language:Spanish
Procedural Safeguards Notice (Spanish) cover image

Procedural Safeguards Notice (Spanish)

Effective Date:4/28/2025 8:07:51 AM
The Procedural Safeguards Notice includes a full explanation of rights available to parents of a school age child with a disability 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 updated contact information and the Bureau of Special Education Complaint Information Packet and Form. Effective Date: April 28, 2025 Age: School Age Language: Spanish
Age:School Age
Language:Spanish
Procedural Safeguards Notice (Russian) cover image

Procedural Safeguards Notice (Russian)

Effective Date:4/28/2025 8:03:22 AM
The Procedural Safeguards Notice includes a full explanation of rights available to parents of a school age child with a disability 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 updated contact information and the Bureau of Special Education Complaint Information Packet and Form. Effective Date: April 28, 2025 Age: School Age Language: Russian
Age:School Age
Language:Russian
Procedural Safeguards Notice (PSN) - Punjabi cover image

Procedural Safeguards Notice (PSN) - Punjabi

Effective Date:7/28/2018 8:40:44 AM
Punjabi Translation of PSN - 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.
Age:School Age
Language:Punjabi
Procedural Safeguards Notice (Portuguese) cover image

Procedural Safeguards Notice (Portuguese)

Effective Date:4/28/2025 12:00:00 AM
The Procedural Safeguards Notice includes a full explanation of rights available to parents of a school age child with a disability 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 updated contact information and the Bureau of Special Education Complaint Information Packet and Form.
Age:School Age
Language:Portuguese
Procedural Safeguards Notice (Nepali) cover image

Procedural Safeguards Notice (Nepali)

Effective Date:4/28/2025 12:09:55 PM
The Procedural Safeguards Notice includes a full explanation of rights available to parents of a school age child with a disability 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 updated contact information and the Bureau of Special Education Complaint Information Packet and Form. Effective Date: April 28, 2025 Age: School Age Language: Nepali
Age:School Age
Language:Nepali
Procedural Safeguards Notice (Italian) cover image

Procedural Safeguards Notice (Italian)

Effective Date:11/17/2014 12:00:00 AM
The Procedural Safeguards Notice includes a full explanation of rights available to parents of a school age child with a disability 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 updated contact information and the Bureau of Special Education Complaint Information Packet and Form.
Age:School Age
Language:Italian
Procedural Safeguards Notice (Indonesian) cover image

Procedural Safeguards Notice (Indonesian)

Effective Date:7/1/2018 10:49:10 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:Indonesian
Procedural Safeguards Notice (Hebrew) cover image

Procedural Safeguards Notice (Hebrew)

Effective Date:7/1/2018 9:42:57 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.
Age:School Age
Language:Hebrew
Procedural Safeguards Notice (Gujarati) cover image

Procedural Safeguards Notice (Gujarati)

Effective Date:7/1/2018 12:33:05 PM
કાર્યપદ્ધતિની સલામતિઓની સૂચના 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.
Age:School Age
Language:Gujarati
Procedural Safeguards Notice (French) cover image

Procedural Safeguards Notice (French)

Effective Date:4/28/2025 7:45:40 AM
The Procedural Safeguards Notice includes a full explanation of rights available to parents of a school age child with a disability 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 updated contact information and the Bureau of Special Education Complaint Information Packet and Form. Effective Date: April 28, 2025 Age: School Age Language: French
Age:School Age
Language:French
Procedural Safeguards Notice (Chinese) cover image

Procedural Safeguards Notice (Chinese)

Effective Date:7/1/2018 12:00:00 AM
The Procedural Safeguards Notice includes a full explanation of rights available to parents of a school age child with a disability 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 updated contact information and the Bureau of Special Education Complaint Information Packet and Form. Effective Date: April 28, 2025 Age: School Age Language: Chinese
Age:School Age
Language:Chinese
Procedural Safeguards Notice (Arabic) cover image

Procedural Safeguards Notice (Arabic)

Effective Date:4/28/2025 7:39:51 AM
The Procedural Safeguards Notice includes a full explanation of rights available to parents of a school age child with a disability 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 updated contact information and the Bureau of Special Education Complaint Information Packet and Form. Effective Date: April 28, 2025 Age: School Age Language: Arabic
Age:School Age
Language:Arabic
PROCEDURAL SAFEGUARDS NOTICE - School Age - Hungarian cover image

PROCEDURAL SAFEGUARDS NOTICE - School Age - Hungarian

Effective Date:7/1/2018 12:00:00 AM
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 - 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 - 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 - 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 - 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 - 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 - 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 cover image

Procedural Safeguards Notice - Preschool Early Intervention

Effective Date:1/31/2025 1:00:00 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 - Polish cover image

Procedural Safeguards Notice - Polish

Effective Date:6/1/2009 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:School Age
Language:Polish
Procedural Safeguards Notice - Haitian Creole cover image

Procedural Safeguards Notice - Haitian Creole

Effective Date:6/15/2022 8:25:35 AM
Procedural Safeguards Notice translated to Haitian Creole
Age:School Age
Language:Haitian Creole
Procedural Safeguards Notice - French cover image

Procedural Safeguards Notice - French

Effective Date:
AVIS DE GARANTIES PROCÉDURALES 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:French
Procedural Safeguards Notice - Early Intervention - Preschool - Korean Version   cover image

Procedural Safeguards Notice - Early Intervention - Preschool - Korean Version

Effective Date:1/1/0001 12:00:00 AM
Korean version of the Procedural Safeguards Notice used by Early Intervention Preschool Programs. This form was revised in July of 2008.
Age:Preschool
Language:Korean
Procedural Safeguards Notice - Early Intervention - Preschool - Chinese VERSION  cover image

Procedural Safeguards Notice - Early Intervention - Preschool - Chinese VERSION

Effective Date:1/1/0001 12:00:00 AM
Chinese version of the Procedural Safeguards Notice used by Early Intervention Preschool Programs. This form was revised in July of 2008.
Age:Preschool
Language:Chinese
Procedural Safeguards Notice - Bengali cover image

Procedural Safeguards Notice - Bengali

Effective Date:4/28/2025 12:00:00 AM
The Procedural Safeguards Notice includes a full explanation of rights available to parents of a school age child with a disability 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 updated contact information and the Bureau of Special Education Complaint Information Packet and Form.
Age:School Age
Language:Bengali
Procedural Safeguards Notice  cover image

Procedural Safeguards Notice

Effective Date:4/28/2025 11:23:44 AM
The Procedural Safeguards Notice includes a full explanation of rights available to parents of a school age child with a disability 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 updated contact information and the Bureau of Special Education Complaint Information Packet and Form.
Age:School Age
Language:English
Procedural Safeguards Letter (Vietnamese) cover image

Procedural Safeguards Letter (Vietnamese)

Effective Date:7/1/2008 12:00:00 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:Vietnamese
Procedural Safeguards Letter (Urdu) cover image

Procedural Safeguards Letter (Urdu)

Effective Date:7/1/2008 12:00:00 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:Urdu
Procedural Safeguards Letter (Ukranian) cover image

Procedural Safeguards Letter (Ukranian)

Effective Date:7/1/2008 12:00:00 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:Ukranian
Procedural Safeguards Letter (Spanish) cover image

Procedural Safeguards Letter (Spanish)

Effective Date:7/1/2018 9:41:03 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:Spanish
Procedural Safeguards Letter (Russian) cover image

Procedural Safeguards Letter (Russian)

Effective Date:7/1/2008 12:00:00 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:Russian
Procedural Safeguards Letter (Italian) cover image

Procedural Safeguards Letter (Italian)

Effective Date:7/1/2008 12:00:00 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:Italian
Procedural Safeguards Letter (Indonesian) cover image

Procedural Safeguards Letter (Indonesian)

Effective Date:7/1/2018 10:17:14 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:Indonesian
Procedural Safeguards Letter (Hebrew) cover image

Procedural Safeguards Letter (Hebrew)

Effective Date:7/1/2018 9:37:46 AM
מכתב אמצעי ביטחון פרוצדורליים 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:Hebrew
Procedural Safeguards Letter (Hatian Creole) cover image

Procedural Safeguards Letter (Hatian Creole)

Effective Date:7/1/2018 3:17:48 PM
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:Haitian Creole
Procedural Safeguards Letter (Gujarati) cover image

Procedural Safeguards Letter (Gujarati)

Effective Date:7/1/2018 12:28:12 PM
કાર્યપદ્ધતિની સલામતીઓનો પત્ર 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:Gujarati
Procedural Safeguards Letter - Preschool Early Intervention Russian cover image

Procedural Safeguards Letter - Preschool Early Intervention Russian

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
Procedural Safeguards Letter - Preschool Early Intervention Khmer cover image

Procedural Safeguards Letter - Preschool Early Intervention 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 Khmer version.
Age:Preschool
Language:Khmer
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
Problem Solving in Early Intervention (Spanish) cover image

Problem Solving in Early Intervention (Spanish)

Effective Date:5/1/2016 12:00:00 AM
This publication is intended to help parents of children receiving early intervention understand their procedural safeguards, parent rights and how to problem solve when they have concerns about their child's early intervention program. 
Age:School Age
Language:Spanish
Problem Solving in Early Intervention (Russian) cover image

Problem Solving in Early Intervention (Russian)

Effective Date:5/1/2016 12:00:00 AM
This publication is intended to help parents of children receiving early intervention understand their procedural safeguards, parent rights and how to problem solve when they have concerns about their child's early intervention program. 
Age:School Age
Language:Russian
Problem Solving in Early Intervention (Portuguese) cover image

Problem Solving in Early Intervention (Portuguese)

Effective Date:5/1/2016 12:00:00 AM
This publication is intended to help parents of children receiving early intervention understand their procedural safeguards, parent rights and how to problem solve when they have concerns about their child's early intervention program. 
Age:School Age
Language:Portuguese
Problem Solving in Early Intervention (Nepali) cover image

Problem Solving in Early Intervention (Nepali)

Effective Date:5/1/2016 12:00:00 AM
This publication is intended to help parents of children receiving early intervention understand their procedural safeguards, parent rights and how to problem solve when they have concerns about their child's early intervention program. 
Age:School Age
Language:Nepali
Problem Solving in Early Intervention (Haitian Creole) cover image

Problem Solving in Early Intervention (Haitian Creole)

Effective Date:5/1/2016 12:00:00 AM
This publication is intended to help parents of children receiving early intervention understand their procedural safeguards, parent rights and how to problem solve when they have concerns about their child's early intervention program. 
Age:School Age
Language:Haitian Creole
Problem Solving in Early Intervention (French) cover image

Problem Solving in Early Intervention (French)

Effective Date:5/1/2016 12:00:00 AM
This publication is intended to help parents of children receiving early intervention understand their procedural safeguards, parent rights and how to problem solve when they have concerns about their child's early intervention program. 
Age:School Age
Language:French
Problem Solving in Early Intervention (Farsi) cover image

Problem Solving in Early Intervention (Farsi)

Effective Date:5/1/2016 12:00:00 AM
This publication is intended to help parents of children receiving early intervention understand their procedural safeguards, parent rights and how to problem solve when they have concerns about their child's early intervention program. 
Age:School Age
Language:Farsi
Problem Solving in Early Intervention (Chinese - Mandarin) cover image

Problem Solving in Early Intervention (Chinese - Mandarin)

Effective Date:5/1/2016 12:00:00 AM
This publication is intended to help parents of children receiving early intervention understand their procedural safeguards, parent rights and how to problem solve when they have concerns about their child's early intervention program. 
Age:School Age
Language:Chinese
Problem Solving in Early Intervention (Arabic) cover image

Problem Solving in Early Intervention (Arabic)

Effective Date:5/1/2016 12:00:00 AM
This publication is intended to help parents of children receiving early intervention understand their procedural safeguards, parent rights and how to problem solve when they have concerns about their child's early intervention program. 
Age:School Age
Language:Arabic
Prior Written Notice Summary (Vietnamese) cover image

Prior Written Notice Summary (Vietnamese)

Effective Date:3/8/2024 8:26:57 AM
The Prior Written Notice for a Reevaluation and Request for Consent form has been separated into two forms, the Prior Written Notice for a Reevaluation form and the Request for Consent for a Reevaluation form. The form was separated into two forms to ensure LEAs provide parents with prior written notice and obtain parent consent at proper times during the reevaluation process in accordance with 34 CFR 300.300 and 300.503.
Age:
Language:Vietnamese
Prior Written Notice for Initial Evaluation and Request for Consent Form (Urdu) cover image

Prior Written Notice for Initial Evaluation and Request for Consent Form (Urdu)

Effective Date:3/30/2015 12:00:00 AM
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:Urdu
Prior Written Notice for Initial Evaluation and Request for Consent Form (Ukranian) cover image

Prior Written Notice for Initial Evaluation and Request for Consent Form (Ukranian)

Effective Date:3/30/2015 12:00:00 AM
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:Ukranian
Prior Written Notice for Initial Evaluation and Request for Consent Form (Swahili) cover image

Prior Written Notice for Initial Evaluation and Request for Consent Form (Swahili)

Effective Date:3/30/2015 2:06:24 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:Swahili
Prior Written Notice for Initial Evaluation and Request for Consent Form (Spanish) cover image

Prior Written Notice for Initial Evaluation and Request for Consent Form (Spanish)

Effective Date:3/30/2015 12:00:00 AM
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:Spanish
Prior Written Notice for Initial Evaluation and Request for Consent Form (Russain) cover image

Prior Written Notice for Initial Evaluation and Request for Consent Form (Russain)

Effective Date:3/30/2015 12:00:00 AM
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:Russian
Prior Written Notice for Initial Evaluation and Request for Consent Form (Polish) cover image

Prior Written Notice for Initial Evaluation and Request for Consent Form (Polish)

Effective Date:3/30/2015 12:00:00 AM
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:Polish
Prior Written Notice for Initial Evaluation and Request for Consent Form (Nepali) cover image

Prior Written Notice for Initial Evaluation and Request for Consent Form (Nepali)

Effective Date:3/30/2015 12:00:00 AM
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:Nepali
Prior Written Notice for Initial Evaluation and Request for Consent Form (Korean) cover image

Prior Written Notice for Initial Evaluation and Request for Consent Form (Korean)

Effective Date:3/30/2015 12:00:00 AM
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:Korean
Prior Written Notice for Initial Evaluation and Request for Consent Form (Khmer) cover image

Prior Written Notice for Initial Evaluation and Request for Consent Form (Khmer)

Effective Date:3/30/2015 12:00:00 AM
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:Khmer
Prior Written Notice for Initial Evaluation and Request for Consent Form (Italian) cover image

Prior Written Notice for Initial Evaluation and Request for Consent Form (Italian)

Effective Date:3/30/2015 12:00:00 AM
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:Italian
Prior Written Notice for Initial Evaluation and Request for Consent Form (Bengali) cover image

Prior Written Notice for Initial Evaluation and Request for Consent Form (Bengali)

Effective Date:3/29/2015 12:00:00 AM
Age:School Age
Language:Bengali