Forms

This site includes forms designed by the Pennsylvania Department of Education to ensure that students with disabilities receive a free, appropriate, public education. Forms are available for the Infant-Toddler/Early Intervention, Preschool/Early Intervention, and School-age programs, and include both annotated and non-annotated versions. Forms are available as Word and pdf documents.

Bureau of Special Education Complaint Form


Access the State Complaint Form on PDE's State Complaints and Dispute Resolution page

State Complaint Forms in other languages are also available on the State Complaints and Dispute Resolution page. 

Complaint Resolution Procedures

If you need more information about the complaint process or if you are unable to print the packet and would like to receive a complaint form by mail, please contact the Special Educaton ConsultLine at 1-800-879-2301, ConsultLine@odr-pa.org or submit an online request.

Results 101-200 of 360
Procedural Safeguards Notice (Bengali) cover image

Procedural Safeguards Notice (Bengali)

Effective Date:7/1/2018 2:09:09 PM
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:Swahili
PROCEDURAL SAFEGUARDS NOTICE - School Age (Vietnamese) cover image

PROCEDURAL SAFEGUARDS NOTICE - School Age (Vietnamese)

Effective Date:7/1/2018 12:00:00 AM
THÔNG BÁO VỀ CÁC BIỆN PHÁP BẢO VỆ THEO QUY TRÌNH - Độ tuổi đến trường The Procedural Safeguards Notice includes a full explanation of all the rights available to parents of a child with a disability ages 3-21 when their child has been referred for or is receiving special education services. This model form provides a format that LEAs may choose to use to provide information about procedural safeguards to parents. This revised Procedural Safeguards Notice includes a change in terminology that replaces the term “mental retardation” with the term “intellectual disability.” This change also aligns the Commonwealth’s special education regulations in Chapters 14 and 711 to the Individuals with Disabilities Education Act (IDEA) regulatory revisions resulting from Rosa’s Law. The change in terminology does not affect the meaning or the eligibility determination associated with the term. Also, this revised notice includes additional resources for parents in Appendix A. In addition, this document contains a revised Office for Dispute Resolution (ODR) Request Form for IEP/IFSP/GIEP Facilitation, Mediation, and a revised Due Process Compliant Request Form in Appendix B. The revised Procedural Safeguards Notice contains the footer “July 2018.” This notice is available in two formats - a Word document and a pdf. Below is the request form for Mediation, IEP/IFSP/GIEP Facilitation and the Due Process Complaint form. The form can be submitted via mail, fax or email; contact information can be found at the bottom of each form. Requests can also be submitted via the online submission form on ODR’s website. Mediation & IEP/IFSP/GIEP Facilitation Request (English) - http://odr-pa.org/iep-ifsp-med-request-form-english/ Mediation & IEP/IFSP/GIEP Facilitation (Spanish) – http://odr-pa.org/mediation-iep-online-request-spanish/ Due Process Complaint (English) - http://odr-pa.org/due-process-online-request/ Due Process Complaint (Spanish) - http://odr-pa.org/due-process-online-request-spanish/ *Note: The online submission forms can be accessed in 11 other languages via the ODR website. They include Albanian, Arabic, Chinese Simplified, Chinese Traditional, French, German, Italian, Japanese, Korean, Russian and Portuguese.
Age:School Age
Language:Vietnamese
PROCEDURAL SAFEGUARDS NOTICE - School Age (French) cover image

PROCEDURAL SAFEGUARDS NOTICE - School Age (French)

Effective Date:7/1/2018 12:00:00 AM
AVIS DE SAUVEGARDE DE PROCÉDURE - Âge Scolaire The Procedural Safeguards Notice includes a full explanation of all the rights available to parents of a child with a disability ages 3-21 when their child has been referred for or is receiving special education services. This model form provides a format that LEAs may choose to use to provide information about procedural safeguards to parents. This revised Procedural Safeguards Notice includes a change in terminology that replaces the term “mental retardation” with the term “intellectual disability.” This change also aligns the Commonwealth’s special education regulations in Chapters 14 and 711 to the Individuals with Disabilities Education Act (IDEA) regulatory revisions resulting from Rosa’s Law. The change in terminology does not affect the meaning or the eligibility determination associated with the term. Also, this revised notice includes additional resources for parents in Appendix A. In addition, this document contains a revised Office for Dispute Resolution (ODR) Request Form for IEP/IFSP/GIEP Facilitation, Mediation, and a revised Due Process Compliant Request Form in Appendix B. The revised Procedural Safeguards Notice contains the footer “July 2018.” This notice is available in two formats - a Word document and a pdf. Below is the request form for Mediation, IEP/IFSP/GIEP Facilitation and the Due Process Complaint form. The form can be submitted via mail, fax or email; contact information can be found at the bottom of each form. Requests can also be submitted via the online submission form on ODR’s website. Mediation & IEP/IFSP/GIEP Facilitation Request (English) - http://odr-pa.org/iep-ifsp-med-request-form-english/ Mediation & IEP/IFSP/GIEP Facilitation (Spanish) – http://odr-pa.org/mediation-iep-online-request-spanish/ Due Process Complaint (English) - http://odr-pa.org/due-process-online-request/ Due Process Complaint (Spanish) - http://odr-pa.org/due-process-online-request-spanish/ *Note: The online submission forms can be accessed in 11 other languages via the ODR website. They include Albanian, Arabic, Chinese Simplified, Chinese Traditional, French, German, Italian, Japanese, Korean, Russian and Portuguese.
Age:School Age
Language:French
PROCEDURAL SAFEGUARDS NOTICE - School Age - Hungarian cover image

PROCEDURAL SAFEGUARDS NOTICE - School Age - Hungarian

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

Procedural Safeguards Notice - Preschool Early Intervention (Khmer)

Effective Date:12/1/2014 9:31:40 AM
The Procedural Safeguards Notice, Khmer version, 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:Khmer
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 - Spanish  VERSION.  cover image

Procedural Safeguards Notice - Preschool Early Intervention - Spanish VERSION.

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

Procedural Safeguards Notice - Arabic Version

Effective Date:7/1/2018 1:20:41 PM
بيان حماية الإجراءات Procedural Safeguards Notice - Arabic Version
Age:School Age
Language:Arabic
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 (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
LÈT GARANTI SOU PWOSEDI YO
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 Vietnamese cover image

Procedural Safeguards Letter - Preschool Early Intervention Vietnamese

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 Vietnamese version.
Age:Preschool
Language:Vietnamese
Procedural Safeguards Letter - Preschool Early Intervention Urdu cover image

Procedural Safeguards Letter - Preschool Early Intervention Urdu

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 Urdu version.
Age:Preschool
Language:Urdu
Procedural Safeguards Letter - Preschool Early Intervention Ukranian cover image

Procedural Safeguards Letter - Preschool Early Intervention Ukranian

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 Ukranian version.
Age:Preschool
Language:Ukranian
Procedural Safeguards Letter - Preschool Early Intervention Spanish cover image

Procedural Safeguards Letter - Preschool Early Intervention Spanish

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 Spanish version.
Age:Preschool
Language:Spanish
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 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 Nepali cover image

Procedural Safeguards Letter - Preschool Early Intervention Nepali

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 Nepali version.
Age:Preschool
Language:Nepali
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 - Preschool Early Intervention Italian cover image

Procedural Safeguards Letter - Preschool Early Intervention Italian

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 Italian version.
Age:Preschool
Language:Italian
Procedural Safeguards Letter - Preschool Early Intervention French Version cover image

Procedural Safeguards Letter - Preschool Early Intervention French Version

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 French version.
Age:Preschool
Language:French
Procedural Safeguards Letter - Preschool Early Intervention Croatian cover image

Procedural Safeguards Letter - Preschool Early Intervention Croatian

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 Croatian version.
Age:Preschool
Language:Croatian
Procedural Safeguards Letter - Preschool Early Intervention Chinese cover image

Procedural Safeguards Letter - Preschool Early Intervention Chinese

Effective Date:1/1/0001 12:00:00 AM
Letter to a parent on their rights and their child’s rights related to early intervention services Chinese version.
Age:Preschool
Language:Chinese
Procedural Safeguards Letter - Preschool Early Intervention Arabic cover image

Procedural Safeguards Letter - Preschool Early Intervention Arabic

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 Arabic version.
Age:Preschool
Language:Arabic
Procedural Safeguards Letter - Preschool Early Intervention Albanian cover image

Procedural Safeguards Letter - Preschool Early Intervention Albanian

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 Albanian version.
Age:Preschool
Language:Albanian
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 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 (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 (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 (Portuguese) cover image

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

Effective Date:3/30/2015 9:08:20 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:Portuguese
Prior Written Notice for Initial Evaluation and Request for Consent Form - School Age (Haitian Creole) cover image

Prior Written Notice for Initial Evaluation and Request for Consent Form - School Age (Haitian Creole)

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:Haitian Creole
Prior Written Notice for Initial Evaluation and Request for Consent Form - School Age (Arabic) cover image

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

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:Arabic
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
Prior Written Notice for Initial Evaluation and Request for Consent Form cover image

Prior Written Notice for Initial Evaluation and Request for Consent Form

Effective Date:3/29/2015 10:51:52 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:Indonesian
Prior Written Notice for Initial Evaluation (Bengali) cover image

Prior Written Notice for Initial Evaluation (Bengali)

Effective Date:4/13/2023 8:04:21 AM
Age:School Age
Language:Bengali
Prior Written Notice for a Reevaluation (Swahili) cover image

Prior Written Notice for a Reevaluation (Swahili)

Effective Date:11/1/2023 8:21:32 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
Prior Written Notice for a Reevaluation (Spanish) cover image

Prior Written Notice for a Reevaluation (Spanish)

Effective Date:11/1/2023 8:16:30 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
Prior Written Notice for a Reevaluation (Russian) cover image

Prior Written Notice for a Reevaluation (Russian)

Effective Date:11/1/2023 8:11:08 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
Prior Written Notice for a Reevaluation (Portuguese) cover image

Prior Written Notice for a Reevaluation (Portuguese)

Effective Date:11/1/2023 8:03:10 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
Prior Written Notice for a Reevaluation (Nepali) cover image

Prior Written Notice for a Reevaluation (Nepali)

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
Prior Written Notice for a Reevaluation (French) cover image

Prior Written Notice 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
Prior Written Notice for a Reevaluation (Chinese) cover image

Prior Written Notice 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
Prior Written Notice for a Reevaluation (Bengali) cover image

Prior Written Notice 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
Prior Written Notice for a Reevaluation (Arabic) cover image

Prior Written Notice 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
Prior Written Notice for a Reevaluation (Annotated) cover image

Prior Written Notice 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
Prior Written Notice for a Reevaluation cover image

Prior Written Notice 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
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 (Khmer) cover image

Preschool Early Intervention Evaluation Report (Khmer)

Effective Date:12/1/2018 9:29:33 AM
Early Intervention Evaluation Report, Khmer version, for use as of December 2018. The Evaluation Report documents information on a child and family, including strengths and needs, provides eligibility determinations, and provides recommendations for supports that can assist the young child to develop, learn and grow.
Age:Preschool
Language:Khmer
Preschool Early Intervention Evaluation Report - Vietnamese cover image

Preschool Early Intervention Evaluation Report - Vietnamese

Effective Date:12/30/2018 9:30:42 AM
Early Intervention Evaluation Report for use as of December 2018. The Evaluation Report documents information on a child and family, including strengths and needs, provides eligibility determinations, and provides recommendations for supports that can assist the young child to develop, learn and grow.
Age:Preschool
Language:Vietnamese
Preschool Early Intervention Evaluation Report - Spanish Version cover image

Preschool Early Intervention Evaluation Report - Spanish Version

Effective Date:12/1/2018 12:00:00 AM
Early Intervention Evaluation Report in Spanish for use as of December 2018. The Evaluation Report documents information on a child and family, including strengths and needs, provides eligibility determinations, and provides recommendations for supports that can assist the young child to develop, learn and grow.
Age:Preschool
Language:Spanish
Preschool Early Intervention Evaluation Report – Annotated  cover image

Preschool Early Intervention Evaluation Report – Annotated

Effective Date:10/1/2023 9:17:30 AM
The Early Intervention 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 – Albanian Version cover image

Preschool Early Intervention Evaluation Report – Albanian Version

Effective Date:12/30/2018 9:26:48 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:Albanian
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
POZIV ZA SUDJELOVANJE NA SASTANKU TIMA IEP ILI DRUGOM SASTANKU - Školska dob cover image

POZIV ZA SUDJELOVANJE NA SASTANKU TIMA IEP ILI DRUGOM SASTANKU - Školska dob

Effective Date:6/29/2015 11:00:00 PM
INVITATION TO PARTICIPATE IN THE IEP TEAM MEETING OR OTHER MEETING - School Age Revidirano u svibnju 2015. - Ovaj novi poziv za sudjelovanje na sastanku tima IEP ili drugom sastanku (s podnožjem uz naznaku “Revizije iz svibnja 2015”.) zamjenjuje trenutačni poziv. Ovaj revidirani obrazac dodaje dopunske svrhe za sastanak tima IEP, uklanja zahtjev za upotrebom dva odvojena obrasca poziva za sudjelovanje na sastanku tima IEP ili drugom sastanku za tranzicijsko planiranje/usluge i dopunjuje objašnjenja za tranzicijsko planiranje i usluge, uključujući izjavu da će lokalna agencija za obrazovanje (LEA) pozvati učenika, ako je dobi 14 godina ili stariji. Ovaj obrazac stupa na snagu od 30. lipnja 2015. Dostupna je objavljena verzija
Age:School Age
Language:Croatian
PLAN DE COMUNICACIÓN PARA NIÑOS SORDOS O CON DISCAPACIDADES AUDITIVAS - Edad escolar   cover image

PLAN DE COMUNICACIÓN PARA NIÑOS SORDOS O CON DISCAPACIDADES AUDITIVAS - Edad escolar

Effective Date:7/1/2008 11:00:00 PM
COMMUNICATION PLAN - School Age El Plan de Comunicación debe ser incluido en el Programa de Educación Individualizada (IEP) de cualquier alumno que sea sordo o tenga problemas auditivos. El formulario del Plan de Comunicación fue revisado en diciembre de 2010. En ese entonces se hicieron adiciones en las Secciones I y III del plan con el fin de incluir las necesidades de comunicación y los dispositivos y servicios de tecnología auxiliar para los alumnos con sordoceguera. El plan revisado tiene un pie de página que dice Diciembre de 2010. Versión con acotaciones disponible
Age:School Age
Language:Spanish
PIANO DI COMUNICAZIONE - ETÀ SCOLARE cover image

PIANO DI COMUNICAZIONE - ETÀ SCOLARE

Effective Date:7/1/2008 11:00:00 PM
COMMUNICATION PLAN - School Age Il Piano di Comunicazione deve essere incluso nell'IEP per ogni studente che è sordo o con problemi dell’udito. Il modulo del Piano di Comunicazione è stato controllato a dicembre 2010. A quel tempo addizioni vennero fatte alle sezioni I e III del Piano per includere i bisogni di comunicazione e i dispositivi tecnologici e i servizi necessari per gli studenti che sono sordi. Il Piano rivisto ha un piè di pagina che legge dicembre 2010. Disponibile la Versione annotata.
Age:School Age
Language:Italian
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 REEVALUATE - Preschool Early Intervention - SPANISH VERSION  cover image

PERMISSION TO REEVALUATE - Preschool Early Intervention - SPANISH VERSION

Effective Date:10/1/2016 9:10:06 AM
Description: Spanish Version of the Preschool Early Intervention Permission to Re-Evaluate form. This form must be issued by the Local Education Agency to obtain written consent to conduct a reevaluation.
Age:Preschool
Language:Spanish
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 (Portuguese) cover image

Permission to Evaluate (Portuguese)

Effective Date:2/1/2014 1:53:37 PM
Description: This is the Portuguese version of the Preschool Early Intervention Permission to Evaluate form. This form must be issued by the Local Education Agency to obtain written consent to conduct an initial evaluation.
Age:Preschool
Language:Portuguese
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 – Albanian Version cover image

PERMISSION TO EVALUATE - Preschool Early Intervention – Albanian Version

Effective Date:3/30/2014 9:24:13 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:Albanian
Permission to Evaluate - Preschool Early Intervention  - Spanish Version cover image

Permission to Evaluate - Preschool Early Intervention - Spanish Version

Effective Date:2/1/2014 8:58:20 AM
Description: Spanish Version of the Preschool Early Intervention Permission to Evaluate form. This form must be issued by the Local Education Agency to obtain written consent to conduct an initial evaluation.
Age:Preschool
Language:Spanish
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
Pennsylvania Medical Assistance Billing Parental Notice (Vietnamese) cover image

Pennsylvania Medical Assistance Billing Parental Notice (Vietnamese)

Effective Date:11/11/2017 2:47:25 PM
This form allows parents to choose whether to give consent to access reimbursement from Medical Assistance for Early Intervention/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:Infant/Toddler,Preschool
Language:Vietnamese
Pennsylvania Medical Assistance Billing Parental Notice - Spanish VERSION  cover image

Pennsylvania Medical Assistance Billing Parental Notice - Spanish VERSION

Effective Date:10/31/2017 11:00:00 PM
The PA Medical Assistance Billing Parental Notice is effective beginning October 2016. This notice informs parents of their rights regarding consent for accessing benefits and insurance to pay for services under the Individuals with Disabilities Education Act (IDEA). Spanish Version.
Age:Infant/Toddler,Preschool
Language:Spanish
Pennsylvania Medical Assistance Billing Parental Notice - Annotated - Spanish VERSION  cover image

Pennsylvania Medical Assistance Billing Parental Notice - Annotated - Spanish VERSION

Effective Date:9/30/2016 11:00:00 PM
This notice informs parents of their rights regarding consent for accessing benefits and insurance to pay for services under the Individuals with Disabilities Education Act (IDEA). 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. Spanish Version
Age:Preschool
Language:Spanish
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 – Albanian Version  cover image

Pennsylvania Medical Assistance Billing Parental Notice – Albanian Version

Effective Date:3/30/2017 9:17:20 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:Infant/Toddler,Preschool
Language:Albanian
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 (Vietnamese) cover image

Pennsylvania Medical Assistance Billing Parental Consent (Vietnamese)

Effective Date:11/1/2017 2:40:47 PM
This form allows parents to choose whether to give consent for to access reimbursement from Medical Assistance for Early Intervention/special education services.
Age:Infant/Toddler,Preschool
Language:Vietnamese
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 – Albanian Version cover image

Pennsylvania Medical Assistance Billing Parental Consent – Albanian Version

Effective Date:3/30/2016 9:20:41 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:Infant/Toddler,Preschool
Language:Albanian
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
Parent's Rights Agreement (SP/EI) cover image

Parent's Rights Agreement (SP/EI)

Effective Date:5/16/2018 1:42:31 PM
This is the Spanish version of the Parent’s Rights Agreement form that summarizes the parent and child’s rights during the Early Intervention process.
Age:Infant/Toddler
Language:Spanish
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, effective beginning July 1, 2008, is to be used when the Local Education Agency (LEA) seeks to obtain consent from the parent to excuse required members of the IEP team from attending an IEP team meeting.
Age:School Age
Language:English
PARENTAL CONSENT TO EXCUSE MEMBERS FROM ATTENDING THE IEP TEAM MEETING - Preschool Early Intervention - SPANISH VERSION cover image

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

Effective Date:2/22/2014 8:15:24 AM
Spanish Version of the Preschool Early Intervention Parental Consent to Excuse Members from Attending the IEP Team Meeting form. 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:Spanish
Parental Consent to Excuse Members from Attending the IEP Team Meeting - Preschool Early Intervention - Russian VERSION cover image

Parental Consent to Excuse Members from Attending the IEP Team Meeting - Preschool Early Intervention - Russian VERSION

Effective Date:1/1/0001 12:00:00 AM
Russian Version of the Preschool Early Intervention Parental Consent to Excuse Members from Attending the IEP Team Meeting form.
Age:Preschool
Language:Russian
PARENTAL CONSENT TO EXCUSE MEMBERS FROM ATTENDING THE IEP TEAM MEETING - Preschool Early Intervention - Chinese VERSION cover image

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

Effective Date:1/1/0001 12:00:00 AM
Chinese Version of the Preschool Early Intervention Parental Consent to Excuse Members from Attending the IEP Team Meeting form.
Age:Preschool
Language:Chinese
Parental Consent to Excuse Members from Attending the IEP Team Meeting - Preschool Early Intervention - Arabic VERSION cover image

Parental Consent to Excuse Members from Attending the IEP Team Meeting - Preschool Early Intervention - Arabic VERSION

Effective Date:1/1/0001 12:00:00 AM
Arabic Version of the Preschool Early Intervention Parental Consent to Excuse Members from Attending the IEP Team Meeting form.
Age:Preschool
Language:Arabic
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 (Portuguese Annotated) cover image

Parent Rights Agreement (Portuguese Annotated)

Effective Date:5/16/2018 9:54:39 AM
This is the Portuguese version of the form that summarizes the parent and child’s rights during the Early Intervention process.
Age:Infant/Toddler
Language:Portuguese
Parent Rights Agreement (Nepali Annotated) cover image

Parent Rights Agreement (Nepali Annotated)

Effective Date:5/16/2018 9:11:38 AM
This is the Nepali version of the form that summarizes the parent and child’s rights during the Early Intervention process.
Age:Infant/Toddler
Language:Nepali
Parent Rights Agreement (Arabic Annotated) cover image

Parent Rights Agreement (Arabic Annotated)

Effective Date:5/16/2018 9:58:21 AM
This is the Arabic version of the form that summarizes the parent and child’s rights during the Early Intervention process.
Age:Infant/Toddler
Language:Arabic