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 301-360 of 360
Individualized Education Program (IEP) - Early Intervention cover image

Individualized Education Program (IEP) - Early Intervention

Effective Date:12/1/2022 2:35:27 PM
The Individualized Education Program (IEP)) is a plan that identify services and supports for preschool age children and their families involved in Early Intervention. The IEP considers the strengths of the child and concerns of the parent/guardian and most recent evaluation results so that family members and early education programs are actively engaged in promoting the child’s learning and development.
Age:Preschool
Language:English
Individualized Education Program (IEP) - Chinese cover image

Individualized Education Program (IEP) - Chinese

Effective Date:2/1/2020 7:49:58 AM
个别化教育计划(IEP)Revised IEP February 1, 2020 – This revised form (with footer February 1, 2020) provides changes to section IV (the elimination of required video recording and narrative notes for students taking the PASA) per the PENN*LINK issued December 16, 2019.
Age:School Age
Language:Chinese
Individualized Education Program (IEP) - (Swahili) cover image

Individualized Education Program (IEP) - (Swahili)

Effective Date:12/16/2019 10:56:57 AM
Revised IEP February 1, 2020 – This revised form (with footer February 1, 2020) provides changes to section IV (the elimination of required video recording and narrative notes for students taking the PASA) per the PENN*LINK issued December 16, 2019.
Age:School Age
Language:Swahili
Individualized Education Program (IEP) - (Portuguese) cover image

Individualized Education Program (IEP) - (Portuguese)

Effective Date:2/1/2020 8:46:47 AM
Revised IEP February 1, 2020 – This revised form (with footer February 1, 2020) provides changes to section IV (the elimination of required video recording and narrative notes for students taking the PASA) per the PENN*LINK issued December 16, 2019.
Age:School Age
Language:Portuguese
Individualized Education Program (IEP) cover image

Individualized Education Program (IEP)

Effective Date:2/1/2020 2:47:42 PM
Revised IEP February 1, 2020 – This revised form (with footer February 1, 2020) provides changes to section IV (the elimination of required video recording and narrative notes for students taking the PASA) per the PENN*LINK issued December 16, 2019.
Age:School Age
Language:English
Individualized Education Plan (Bengali) cover image

Individualized Education Plan (Bengali)

Effective Date:2/1/2020 8:04:21 AM
Age:School Age
Language:Bengali
IEPチームミーティングまたは他のミーティング参加への案内状—学齢 cover image

IEPチームミーティングまたは他のミーティング参加への案内状—学齢

Effective Date:6/29/2015 11:00:00 PM
INVITATION TO PARTICIPATE IN THE IEP TEAM MEETING OR OTHER MEETING - School Age 2015年3月改訂—新しいIEPチームミーティングまたは他のミーティング参加への案内状(2015年3月改訂とフッタにある)は現行の案内状と代わります。この改訂されたフォームはIEPチームミーティングの補助的な目的を加えています。またIEPチームミーティングまたは他のミーティング参加への案内状のフォームを2つに分け使用する必要事項を取り除いています。そして、移行プランとサービスの説明を補足しています。生徒が14歳以上である場合、地域の教育機関(LEA)がその生徒を招待する旨を含みます。このフォームは2015年6月30日より有効となります。
Age:School Age
Language:Japanese
IEPチームミーティングへの参加からメンバーを免除する親の承諾—学齢 cover image

IEPチームミーティングへの参加からメンバーを免除する親の承諾—学齢

Effective Date:6/30/2008 11:00:00 PM
PARENTAL CONSENT TO EXCUSE MEMBERS FROM ATTENDING THE IEP TEAM MEETING - School Age このフォームは2008年7月1日から有効で、改訂されたチャプター14と711の新しい条項に反映されます。この新しい案内状(フッタに2008年7月改訂とある)は現在の案内状に代わります。。この案内状はIEPチームミーティングへの参加からIEPのチームメンバーを免除する親の承諾のリクエストをこれ以上含みません。このリクエストは現在別のフォーム「IEP チームミーティングへの参加からメンバーを免除する親の承諾」によって行われます。
Age:School Age
Language:Japanese
IEP 팀 모임 참석 면제에 관한 학부모 동의서 - 취학 연령 cover image

IEP 팀 모임 참석 면제에 관한 학부모 동의서 - 취학 연령

Effective Date:6/30/2008 11:00:00 PM
PARENTAL CONSENT TO EXCUSE MEMBERS FROM ATTENDING THE IEP TEAM MEETING - School Age 본 양식은 2008년 1월 1일부터 유효하며 개정된 14조 및 711조의 새로운 조항을 반영합니다. 개정된 초청장("2008년 7월 개정"이라는 바닥글 추가)은 현재 초청장을 대체합니다. 본 초청장부터는 IEP 팀 모임 참석 면제에 관한 학부모 동의 요청서를 포함하지 않습니다. 본 요청은 지금부터, "IEP 팀 모임 참석 면제에 관한 학부모 동의서"라는 별도의 양식으로 이루어집니다. 해설판 이용 가능
Age:School Age
Language:Korean
IEP बैठकमा उपस्थित हुन सदस्यहरूलाई छुट दिने अभिभावकीय मञ्जुरी - विद्यालय जाने उमेर cover image

IEP बैठकमा उपस्थित हुन सदस्यहरूलाई छुट दिने अभिभावकीय मञ्जुरी - विद्यालय जाने उमेर

Effective Date:6/30/2008 11:00:00 PM
PARENTAL CONSENT TO EXCUSE MEMBERS FROM ATTENDING THE IEP TEAM MEETING - School Age यो फाराम जुलाई 1, 2008 को सुरुवातमा प्रभावकारी भएको हो र संशोधित च्याप्टरहरू 14 र 711 का नयाँ प्रावधानहरूलाई प्रतिबिम्बित गर्छ। यस नयाँ आमन्त्रण (“जुलाई 2008 संशोधनहरू” को पादलेख सहित) ले हालको आमन्त्रणलाई प्रतिस्थापित गर्छ। यस आमन्त्रणमा अब उपरान्त IEP टोलीका सदस्यहरूलाई IEP टोली बैठकमा उपस्थित छुट दिनका लागि अभिभावकीय मञ्जुरीको अनुरोध समावेश हुँदैन। यस अनुरोधलाई अहिले छुट्टै फाराम “IEP टोलीका सदस्यहरूलाई IEP टोली बैठकमा उपस्थित छुट दिनका लागि अभिभावकीय मञ्जुरी” को रूपमा बनाइएको छ। व्याख्या गरिएको संस्करण उपलब्ध छ
Age:School Age
Language:Nepali
IEP टोली बैठक वा अन्य बैठकमा सहभागी हुन आमन्त्रण - विद्यालय जाने उमेर cover image

IEP टोली बैठक वा अन्य बैठकमा सहभागी हुन आमन्त्रण - विद्यालय जाने उमेर

Effective Date:6/29/2015 11:00:00 PM
INVITATION TO PARTICIPATE IN THE IEP TEAM MEETING OR OTHER MEETING - School Age संशोधित मे 2015 – IEP टोली बैठक वा अन्य बैठकमा (“मे 2015 संशोधनहरू”मा संकेत गरिएको पादलेख सहित) मा सहभागी हुन यस नयाँ आमन्त्रणले हालको आमन्त्रणलाई प्रतिस्थापन गर्छ। यस संशोधित फारामले IEP टोली बैठकका पूरक उद्देश्यहरूलाई थप्दछ, IEP टोली बैठक वा पारगमन योजना/सेवाहरूका लागि निर्मित अन्य बैठकमा सहभागी हुन छुट्टै आमन्त्रणको प्रयोग गर्ने आवश्यकतालाई हटाउँछ र विद्यार्थीको उमेर 14 वर्ष वा सोभन्दा बढी भएमा स्थानीय शिक्षा निकाय (LEA) आमन्त्रण गर्ने कथन सहित पारगमन योजना तथा सेवाहरूको व्याख्याहरूलाई पूरक गर्छ। यो फाराम मङ्गलवार, जून 30, 2015 को सुरुवात देखि प्रभावकारी छ। व्याख्या गरिएको संस्करण उपलब्ध छ
Age:School Age
Language:Nepali
IEP ٹیم کی میٹنگ یا دیگر میٹنگ میں شرکت کی دعوت - اسکولی عمر cover image

IEP ٹیم کی میٹنگ یا دیگر میٹنگ میں شرکت کی دعوت - اسکولی عمر

Effective Date:6/29/2015 11:00:00 PM
INVITATION TO PARTICIPATE IN THE IEP TEAM MEETING OR OTHER MEETING - School Age

ترمیم شدہ مئی 2015 – IEP ٹیم میٹنگ یا دیگر میٹنگ میں شرکت کے لیے یہ نیا دعوت نامہ (جس کے فوٹر میں "مئی 2015 ترامیم" درج ہے) موجودہ دعوت نامے کی جگہ لیتاہے۔ یہ ترمیم شدہ فارم IEP ٹیم میٹنگ کے لیے تکملاتی مقاصد شامل کرتا ہے، IEP ٹیم میٹنگ میں شرکت یا منتقلی کی منصوبہ بندی/ خدمات سے متعلق دیگر میٹنگ کے فارموں کے لیے دو علیحدہ دعوت نامے استعمال کرنے کے تقاضے کو ختم کرتا ہے، اور منتقلی کی منصوبہ بندی اور خدمات کی وضاحت کا اضافہ کرتا ہے، بشمول اس بیان کے کہ مقامی تعلیمی ایجنسی (LEA) طالب علم کو مدعو کرے گی، اگر اس کی عمر 14 سال یا زیادہ ہو۔ یہ فارم 30 جون، 2008 سے مؤثر ہے۔ شرح کے ساتھ ورژن دستیاب ہے

Age:School Age
Language:Urdu
FTESË PËR PJESËMARRJE NË MBLEDHJEN E EKIPIT IEP OSE NË NJË MBLEDHJE TJETËR - Mosha shkollore cover image

FTESË PËR PJESËMARRJE NË MBLEDHJEN E EKIPIT IEP OSE NË NJË MBLEDHJE TJETËR - Mosha shkollore

Effective Date:6/29/2015 11:00:00 PM
INVITATION TO PARTICIPATE IN THE IEP TEAM MEETING OR OTHER MEETING - School Age Ribotuar në maj 2015 - Kjo Ftesë e re për Pjesëmarrje në Mbledhjen e Ekipit IEP ose në një Mbledhje Tjetër (me shënim në fund që shkruan "Ribotim, Maj 2015") zëvendëson ftesën aktuale. Ky formular i ribotuar shton synime të reja për mbledhjet IEP, heq kushtin për përdorimin e dy formularëve të ndryshëm të Ftesave për Pjesëmarrje në Mbledhjen e Ekipit IEP ose në një Mbledhje Tjetër për planifikimin/shërbimet e tranzicionit, dhe zgjeron shpjegimet mbi planifikimin e shërbimet e tranzicionit, përfshirë deklaratë që qendra lokale e arsimit (LEA) do të ftojë nxënësin nëse është 14 vjeç e sipër. Ky formular hyn në fuqi në 30 qershor, 2008. Versioni i shpjeguar në dispozicion
Age:School Age
Language:Albanian
Evaluation Report-Annotated cover image

Evaluation Report-Annotated

Effective Date:7/1/2018 8:41:03 AM
This revised Evaluation Report (Annotated) includes a change in terminology that replaces the term “mental retardation” with the term “intellectual disability.” This change also aligns the Commonwealth’s special education regulations in Chapters 14 and 711 to the Individuals with Disabilities Education Act (IDEA) regulatory revisions resulting from Rosa’s Law. The change in terminology does not affect the meaning or the eligibility determination associated with the term. (July 2018)
Age:School Age
Language:English
Evaluation Report (Swahili) cover image

Evaluation Report (Swahili)

Effective Date:7/1/2018 10:43:11 AM
This revised Evaluation Report (July 2018) replaces the July 2008 version and includes a change in terminology that replaces the term “mental retardation” with the term “intellectual disability.” This change also aligns the Commonwealth’s special education regulations in Chapters 14 and 711 to the Individuals with Disabilities Education Act (IDEA) regulatory revisions resulting from Rosa’s Law. The change in terminology does not affect the meaning or the eligibility determination associated with the term.
Age:School Age
Language:Swahili
Evaluation Report (Russian) cover image

Evaluation Report (Russian)

Effective Date:7/1/2018 12:00:00 AM
ОТЧЕТ ОБ ОЦЕНИВАНИИ (ER) — школьный возраст This revised Evaluation Report (July 2018) replaces the July 2008 version and includes a change in terminology that replaces the term “mental retardation” with the term “intellectual disability.” This change also aligns the Commonwealth’s special education regulations in Chapters 14 and 711 to the Individuals with Disabilities Education Act (IDEA) regulatory revisions resulting from Rosa’s Law. The change in terminology does not affect the meaning or the eligibility determination associated with the term.
Age:School Age
Language:Russian
Evaluation Report (Portuguese) cover image

Evaluation Report (Portuguese)

Effective Date:7/1/2018 8:30:15 AM
This revised Evaluation Report (July 2018) replaces the July 2008 version and includes a change in terminology that replaces the term “mental retardation” with the term “intellectual disability.” This change also aligns the Commonwealth’s special education regulations in Chapters 14 and 711 to the Individuals with Disabilities Education Act (IDEA) regulatory revisions resulting from Rosa’s Law. The change in terminology does not affect the meaning or the eligibility determination associated with the term.
Age:School Age
Language:Portuguese
Evaluation Report (Nepali) cover image

Evaluation Report (Nepali)

Effective Date:4/13/2023 8:04:21 AM
Age:School Age
Language:Nepali
Evaluation Report (Indonesian) cover image

Evaluation Report (Indonesian)

Effective Date:7/1/2018 1:29:00 PM
This revised Evaluation Report (July 2018) replaces the July 2008 version and includes a change in terminology that replaces the term “mental retardation” with the term “intellectual disability.” This change also aligns the Commonwealth’s special education regulations in Chapters 14 and 711 to the Individuals with Disabilities Education Act (IDEA) regulatory revisions resulting from Rosa’s Law. The change in terminology does not affect the meaning or the eligibility determination associated with the term.
Age:School Age
Language:Indonesian
Evaluation Report (Hebrew) cover image

Evaluation Report (Hebrew)

Effective Date:7/1/2018 8:30:53 AM
גיל בית הספר This revised Evaluation Report (July 2018) replaces the July 2008 version and includes a change in terminology that replaces the term “mental retardation” with the term “intellectual disability.” This change also aligns the Commonwealth’s special education regulations in Chapters 14 and 711 to the Individuals with Disabilities Education Act (IDEA) regulatory revisions resulting from Rosa’s Law. The change in terminology does not affect the meaning or the eligibility determination associated with the term.
Age:School Age
Language:Hebrew
Evaluation Report (Haitian Creole) cover image

Evaluation Report (Haitian Creole)

Effective Date:7/1/2018 1:46:58 PM
RAPÒ EVALYASYON (ER)
Age:School Age
Language:Haitian Creole
EVALUATION REPORT (ER) - School Age (Vietnamese) cover image

EVALUATION REPORT (ER) - School Age (Vietnamese)

Effective Date:7/1/2018 12:00:00 AM
BÁO CÁO ĐÁNH GIÁ (BCĐG) - Độ tuổi đến trường This revised Evaluation Report (July 2018) replaces the July 2008 version and includes a change in terminology that replaces the term “mental retardation” with the term “intellectual disability.” This change also aligns the Commonwealth’s special education regulations in Chapters 14 and 711 to the Individuals with Disabilities Education Act (IDEA) regulatory revisions resulting from Rosa’s Law. The change in terminology does not affect the meaning or the eligibility determination associated with the term.
Age:School Age
Language:Vietnamese
EVALUATION REPORT (ER) - School Age (French) cover image

EVALUATION REPORT (ER) - School Age (French)

Effective Date:7/1/2018 12:00:00 AM
RAPPORT D'ÉVALUATION (ER) - Age scolaire This revised Evaluation Report (July 2018) replaces the July 2008 version and includes a change in terminology that replaces the term “mental retardation” with the term “intellectual disability.” This change also aligns the Commonwealth’s special education regulations in Chapters 14 and 711 to the Individuals with Disabilities Education Act (IDEA) regulatory revisions resulting from Rosa’s Law. The change in terminology does not affect the meaning or the eligibility determination associated with the term.
Age:School Age
Language:French
Evaluation Report (Chinese) cover image

Evaluation Report (Chinese)

Effective Date:4/13/2023 8:04:21 AM
Age:School Age
Language:Chinese
Evaluation Report (Bengali) cover image

Evaluation Report (Bengali)

Effective Date:4/13/2023 8:04:21 AM
Age:School Age
Language:Bengali
Evaluation Report (Arabic) cover image

Evaluation Report (Arabic)

Effective Date:4/13/2023 8:04:21 AM
Age:School Age
Language:Arabic
Evaluation Report - Early Intervention Infant/Toddler - Vietnamese Version cover image

Evaluation Report - Early Intervention Infant/Toddler - Vietnamese Version

Effective Date:
Vietnamese Version of the Infant/Toddler Early Intervention Evaluation Report.
Age:Infant/Toddler
Language:Vietnamese
Evaluation Report  cover image

Evaluation Report

Effective Date:7/1/2018 8:41:03 AM
This revised Evaluation Report (July 2018) replaces the July 2008 version and includes a change in terminology that replaces the term “mental retardation” with the term “intellectual disability.” This change also aligns the Commonwealth’s special education regulations in Chapters 14 and 711 to the Individuals with Disabilities Education Act (IDEA) regulatory revisions resulting from Rosa’s Law. The change in terminology does not affect the meaning or the eligibility determination associated with the term.
Age:School Age
Language:English
ELTERLICHE ZUSTIMMUNG FÜR DAS ENTSCHULDIGTE FEHLEN VON MITGLIEDERN BEIM IEP TEAM MEETING – Schulalter cover image

ELTERLICHE ZUSTIMMUNG FÜR DAS ENTSCHULDIGTE FEHLEN VON MITGLIEDERN BEIM IEP TEAM MEETING – Schulalter

Effective Date:6/30/2008 11:00:00 PM
PARENTAL CONSENT TO EXCUSE MEMBERS FROM ATTENDING THE IEP TEAM MEETING Dieses Formular ist gültig ab dem 1. Juli 2008 und berücksichtigt neue Vorschriften der revidierten Kapitel 14 und 711. Diese neue Einladung (mit der Fußzeile „Revisionen Juli 2008“) ersetzt die jetzige Einladung. Diese Einladung beinhaltet nicht mehr den Antrag auf elterliche Zustimmung für das entschuldigte Fehlen von Mitgliedern des IEP Teams beim IEP Team Meeting. Dieser Antrag ist jetzt in einem gesonderten Formular - „Elterliche Zustimmung für das entschuldigte Fehlen von Mitgliedern beim IEP Team Meeting.“
Age:School Age
Language:German
EINLADUNG ZUR TEILNAHME AM IEP TEAM MEETING ODER EINEM ANDEREN MEETING – Schulalter cover image

EINLADUNG ZUR TEILNAHME AM IEP TEAM MEETING ODER EINEM ANDEREN MEETING – Schulalter

Effective Date:6/14/2015 11:00:00 PM
INVITATION TO PARTICIPATE IN THE IEP TEAM MEETING OR OTHER MEETING Revidiert - Mai 2015 - Diese neue Einladung zur Teilnahme am IEP Team Meeting oder einem anderen Meeting (mit Fußzeile „Revisionen Mai 2015“) ersetzt die jetzige Einladung. Dieses revidierte Formular fügt ergänzende Bestimmungen für ein IEP Teammeeting zu, behebt die Anforderung zwei gesonderte Einladungen zur Teilnahme am IEP Teammeeting oder einem anderen Meeting über Übergangsplanung/-dienstleistungen zu verwenden, und ergänzt die Erklärungen für Übergangsplanung und -dienstleistungen, einschließlich einer Aussage, dass die Örtliche Schulbehörde (LEA) den Schüler einladen wird, wenn er/sie 14 oder älter ist. Dieses Formular ist gültig ab dem 30. Juni 2015.
Age:School Age
Language:German
Early Intervention Session Note - Annotated cover image

Early Intervention Session Note - Annotated

Effective Date:7/1/2023 11:13:55 AM
This document provides annotated guidance for using the Early Intervention session note form. The session note reflects the Key Principles of Early Intervention in PA. It documents the provision of services and supports, assures communication with families or caregivers, and provides a mechanism to monitor the progress toward the Individualized Family Service Plan (IFSP) outcomes/goals
Age:Infant/Toddler
Language:English
Early Intervention Session Note cover image

Early Intervention Session Note

Effective Date:7/1/2023 11:11:32 AM
This standardized session note form is to be used by all Infant/Toddler Early Intervention programs. The session note reflects the Key Principles of Early Intervention in PA. It documents the provision of services and supports, assures communication with families or caregivers, and provides a mechanism to monitor the progress toward the Individualized Family Service Plan (IFSP) outcomes/goals.
Age:Infant/Toddler
Language:English
CONSENTIMIENTO DEL PADRE PARA EXCUSAR A UN MIEMBRO DEL EQUIPO DE ASISTIR A LA REUNIÓN DEL PROGRAMA DE EDUCACIÓN INDIVIDUALIZADO (IEP por sus siglas en inglés) - Edad escolar cover image

CONSENTIMIENTO DEL PADRE PARA EXCUSAR A UN MIEMBRO DEL EQUIPO DE ASISTIR A LA REUNIÓN DEL PROGRAMA DE EDUCACIÓN INDIVIDUALIZADO (IEP por sus siglas en inglés) - Edad escolar

Effective Date:6/30/2008 11:00:00 PM
PARENTAL CONSENT TO EXCUSE MEMBERS FROM ATTENDING THE IEP TEAM MEETING - School Age Este formulario entrará en vigor a partir del 1° de julio de 2008 y refleja las nuevas disposiciones de los Capítulos 14 y 711 revisados. Esta nueva Invitación (con un pie de página que indica “Revisiones de julio de 2008”) reemplaza a la Invitación actual. Esta Invitación ya no contiene la petición del consentimiento de los padres en cuanto a eximir a los miembros del equipo IEP de asistir a la reunión del equipo IEP. Esta petición ahora se hace con un formulario por separado, “Consentimiento de los Padres de Eximir a los Miembros de Asistir a la Reunión del Equipo IEP”. Versión con acotaciones disponible
Age:School Age
Language:Spanish
CONSENSO GENITORIALE PER SCUSARE I MEMBRI DI PARTECIPARE ALL’ INCONTRO DELLA SQUADRA - ETÀ SCOLARE cover image

CONSENSO GENITORIALE PER SCUSARE I MEMBRI DI PARTECIPARE ALL’ INCONTRO DELLA SQUADRA - ETÀ SCOLARE

Effective Date:6/30/2008 11:00:00 PM
PARENTAL CONSENT TO EXCUSE MEMBERS FROM ATTENDING THE IEP TEAM MEETING - School Age Questo modulo entra in vigore a partire dal 1 ° luglio 2008 e riflette nuove disposizioni dei capitoli 14 e 711 rivisti. Questo nuovo invito (con un piè di pagina che indica "Revisioni di luglio 2008") sostituisce l'invito attuale. Questo invito non contiene più la richiesta di consenso dei genitori per scusare i membri della aquadra IEP di partecipare all’incontro della aquadra IEP. Questa richiesta è ora fatta con un modulo separato, "Consenso genitoriale per scusare i membri di partecipare all’ incontro della aquadra IEP". Disponibile la Versione annotata.
Age:School Age
Language:Italian
Complaint Resolution Process - Early Intervention  cover image

Complaint Resolution Process - Early Intervention

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

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

Effective Date:10/14/2022 9:30:35 AM
The primary purpose of the Communication Plan is to establish discussion among all IEP team members who review the student’s needs based on communication skills and access. The Communication Plan should be the starting point for the IEP, and the results of this discussion should be used to identify the student’s present educational levels as well as to complete other sections of the IEP. The Annotated Communication Plan was revised in July 2022. At that time changes were made in Sections l, lll, and IV. Sections have been reduced to l and ll. Changes have been made in the following areas: Section l, including assessments and data to determine the student’s language and communication mode, and a revised chart to inform the school team of the student’s preferred method for learning and communication. Section ll, describe how the student is accessing grade level curriculum and instruction, and how is it delivered directly to the student using preferred language and communication mode. Glossary terms have also been added, revised, or deleted as appropriate. The revised version has October 14, 2022 in the footer.
Age:School Age
Language:English
COMMUNICATION PLAN - School Age  cover image

COMMUNICATION PLAN - School Age

Effective Date:10/14/2022 9:27:02 AM
The Communication Plan must be included in the IEP of any student who is deaf or hard of hearing. The Communication Plan form was revised July 2022. At that time changes were made in Sections l, lll, and IV. Sections have been reduced to Sections l and Section ll. Section l: Language and Communication Needs, includes a sign-in area for contributors, asks for data to support conclusions and includes a chart to address primary language and communication mode. Section lll has updated the language for assistive technology, devices, and services. Section lll requires the team to examine if the student has appropriate academic language and communication skills to participate in and access curriculum and instruction. Section lV, Full Range of Needs, has been made into a question thus requiring more discussion. Glossary terms have also been added, revised or deleted as appropriate. The revised plan has a footer reading October 14, 2022. Annotated version available
Age:School Age
Language:English
CHẤP THUẬN CỦA CHA MẸ XIN LỖI CÁC THÀNH VIÊN KHÔNG THAM DỰ CUỘC HỌP NHÓM IEP - Độ tuổi đến trường cover image

CHẤP THUẬN CỦA CHA MẸ XIN LỖI CÁC THÀNH VIÊN KHÔNG THAM DỰ CUỘC HỌP NHÓM IEP - Độ tuổi đến trường

Effective Date:6/30/2008 11:00:00 PM
PARENTAL CONSENT TO EXCUSE MEMBERS FROM ATTENDING THE IEP TEAM MEETING - School Age Biểu mẫu này có hiệu lực từ ngày 1 tháng 7 năm 2008 và phản ánh những điều khoản mới của các Chương sửa đổi số 14 và 711. Thư mời mới này (với phần chú thích trang ghi "Sửa đổi tháng 7 năm 2008”) thay thế cho Thư mời hiện thời. Thư mời này không bao gồm yêu cầu có sự chấp thuận của cha mẹ xin lỗi các thành viên nhóm IEP không tham dự cuộc họp nhóm IEP. Yêu cầu này được lập bằng biểu mẫu riêng, "Chấp thuận của Cha mẹ Xin lỗi các Thành viên Không tham dự Họp Nhóm IEP.” Bản chú giải có sẵn
Age:School Age
Language:Vietnamese
Carta de las Garantías Procesales cover image

Carta de las Garantías Procesales

Effective Date:7/1/2018 8:41:03 AM
Procedural Safeguards Letter--School Age Esta Carta de las Garantías procesales revisada (con un pie de página que indica “Revisiones hechas en julio de 2008”) reemplaza a la Carta de Salvaguardias Procesales con fecha del 1° de julio de 2008. Esta carta revisada incluye un cambio en la terminología que reemplaza el término "retraso mental" por el término "discapacidad intelectual". Este cambio también alinea las regulaciones de educación especial del estado de PA que aparecen en el Capítulo 14 con las revisiones reglamentarias de la Ley de Educación para Individuos con Discapacidades (IDEA) que derivan de la ley Rosa’s Law. No hay ningún otro cambio en las regulaciones actuales del Capítulo 14 o del 711.
Age:School Age
Language:Spanish
AVVISO PRECEDENTE PER ISCRITTO ALLA VALUTAZIONE INIZIALE E MODULO DI RICHIESTA DI CONSENSO - ETÀ SCOLARE cover image

AVVISO PRECEDENTE PER ISCRITTO ALLA VALUTAZIONE INIZIALE E MODULO DI RICHIESTA DI CONSENSO - ETÀ SCOLARE

Effective Date:3/29/2015 11:00:00 PM
Prior Written Notice for Initial Evaluation and Request for Consent Form - School Age Questo nuovo modulo entra in vigore a partire dal 30 marzo 2015 e mostra che i requisiti per le valutazioni iniziali sono soggetti ai requisiti di avviso di IDEA in 34 CFR Sec. 300.503-300.504, e i requisiti per il consenso dei genitori in 34 CFR Sec. 300 300. Secondo il 34 CFR Sec. 300 503 (a) l’Agenzia di Educazione Locale (LEA) deve comunicare per iscritto ai genitori di un bambino con una disabilità le procedure di valutazione che l'agenzia si propone di effetuare, e deve darsi ai genitori di un bambino con una disabilità un tempo ragionevole prima che l'agenzia pubblica: (1) Proponga di avviare o modificare l'individuazione, la valutazione o il collocamento educativo del bambino o la fornitura di una libera educazione pubblica adeguata (FAPE) al bambino; o (2) Rifiuti di avviare o modificare l'individuazione, la valutazione o il collocamento educativo del bambino o la fornitura di FAPE al bambino. Questo Avviso Precedente per Iscritto alla Valutazione Iniziale e il Modulo di Richiesta di Consenso comprende i requisiti di avviso e l’approvazione per la valutazione iniziale. Questo modulo sostituisce il Permesso di Valutazione - Modulo di Consenso. Contiene il piè di pagina "Rivisto Gennaio 2015". Disponibile la Versione annotata.
Age:School Age
Language:Italian
AVVISO DI INSERIMENTO SCOLASTICO CONSIGLIATO/COMUNICAZIONE SCRITTA PRELIMINARE (NOREP/PWN) - ETÀ SCOLARE cover image

AVVISO DI INSERIMENTO SCOLASTICO CONSIGLIATO/COMUNICAZIONE SCRITTA PRELIMINARE (NOREP/PWN) - ETÀ SCOLARE

Effective Date:11/16/2014 11:00:00 PM
NOTICE OF RECOMMENDED EDUCATIONAL PLACEMENT/PRIOR WRITTEN NOTICE (NOREP/PWN) - School Age Questo modulo NOREP/PWN fornisce un modulo che i LEA possono scegliere per comunicare ai genitori il programma educativo consigliato per il loro bambino e altre azioni prese dal LEA. Questo NOREP/PWN rivisto include risorse aggiuntive per i genitori alla pagina 4. Il modulo aggiornato contiene il piè di pagina "Ottobre 2014". Disponibile la Versione annotata.
Age:School Age
Language:Italian
AVVISO DI GARANZIE PROCEDURALI - ETÀ SCOLARE cover image

AVVISO DI GARANZIE PROCEDURALI - ETÀ SCOLARE

Effective Date:11/16/2014 11:00:00 PM
PROCEDURAL SAFEGUARDS NOTICE - School Age L'avviso di garanzie procedurali include una spiegazione completa di tutti i diritti disponibili per i genitori di un bambino di 3-21 anni con una disabilità quando il loro bambino è stato raccomandato per o é ricevendo servizi di educazione speciale. Tale modello di modulo fornisce un formato che LEA può scegliere di utilizzare per fornire informazioni sulle garanzie procedurali per i genitori. Il presente Avviso di garanzie procedurali include risorse supplementari per i genitori in Appendice A. Questo documento contiene anche un modulo di richiesta rivisto per l’Ufficio di Risoluzione delle Controversie (ODR) per la Consulenza IEP/IFSP, Mediazione, Conferenza di Conciliazione Valutativa (ECC) e un modulo di Richiesta di Processo di Regolazione di Reclami rivisto. L’avviso di garanzie procedurali contiene il piè di pagina "Ottobre 2014."
Age:School Age
Language:Italian
AVISO DE UBICACIÓN EDUCATIVA RECOMENDADA/AVISO PREVIO POR ESCRITO cover image

AVISO DE UBICACIÓN EDUCATIVA RECOMENDADA/AVISO PREVIO POR ESCRITO

Effective Date:10/1/2014 12:58:21 PM
Para la LEA use solamente la casilla: Registrar la fecha hábil en que se entrega este formulario a la LEA. Esto representará la documentación que el padre respondió en el NOREP/PWN.
Age:School Age
Language:Spanish
AVISO DE GARANTÍAS DE PROCEDIMIENTO cover image

AVISO DE GARANTÍAS DE PROCEDIMIENTO

Effective Date:7/1/2018 8:41:03 AM
Procedural Safeguards Notice-School Age El Aviso de garantías procesales incluye una explicación completa de todos los derechos disponibles para los padres de un niño con una discapacidad de 3 a 21 años de edad cuando su hijo ha sido referido o está recibiendo servicios de educación especial. Este formulario de modelo proporciona un formato que las Agencias de Educación Locales pueden elegir para proveer a los padres información sobre las garantías procesales. Este Aviso de garantías procesales revisado incluye un cambio en la terminología que reemplaza el término "retraso mental" por el término "discapacidad intelectual". Este cambio también alinea las regulaciones de educación especial del Estado en los Capítulos 14 y 711 con las revisiones reglamentarias de la Ley de Educación para Personas con Discapacidades (IDEA, por sus siglas en inglés) que resultan de la Ley de Rosa. El cambio en la terminología no afecta el significado o la determinación de elegibilidad asociada con el término. Además, este aviso revisado incluye recursos adicionales para los padres en el Apéndice A. Además, este documento contiene un Formulario de solicitud revisado de la Oficina de Resolución de Disputas (ODR) para la facilitación, la mediación del IEP / IFSP / GIEP y un formulario de solicitud revisado que cumple con el debido proceso en el Apéndice B. El Aviso de garantías procesales revisado contiene el pie de página "Julio de 2018". Este formulario está disponible en dos formatos: un documento de Word y un pdf. A continuación se encuentra el formulario de solicitud de Mediación, Facilitación IEP / IFSP / GIEP y el formulario de quejas de Debido Proceso. El formulario puede ser enviado por correo, fax o correo electrónico; la información de contacto se puede encontrar en la parte inferior de cada formulario. Las solicitudes también se pueden enviar a través del formulario de envío en línea en el sitio web de la ODR. Mediación y solicitud de facilitación IEP / IFSP / GIEP (inglés) - http://odr-pa.org/iep-ifsp-med-request-form-english/ Mediación y Facilitación IEP / IFSP / GIEP (en español) - http://odr-pa.org/mediation-iep-online-request-spanish/ Queja de debido proceso (en inglés) - http://odr-pa.org/due-process-online-request/ Queja de debido proceso (en español) - http://odr-pa.org/due-process-online-request-spanish/ *Nota: Se puede acceder a los formularios de presentación en línea en otros 11 idiomas a través del sitio web de la ODR. Incluyen albanés, árabe, chino simplificado, chino tradicional, francés, alemán, italiano, japonés, coreano, ruso y portugués.
Age:School Age
Language:Spanish
AVIS DE PLACEMENT SCOLAIRE RECOMMANDE / PREAVIS ECRIT (NOREP/PWN) - Âge Scolaire cover image

AVIS DE PLACEMENT SCOLAIRE RECOMMANDE / PREAVIS ECRIT (NOREP/PWN) - Âge Scolaire

Effective Date:11/16/2014 11:00:00 PM
NOTICE OF RECOMMENDED EDUCATIONAL PLACEMENT/PRIOR WRITTEN NOTICE (NOREP/PWN) - School Age Ce formulaire NOREP/PWN offre un format que les LEA peuvent choisir de communiquer aux parents le programme éducatif recommandé pour leur enfant et d'autres mesures prises par l’ LEA. Ce NOREP/PWN révisé comprend des ressources supplémentaires pour les parents à la page 4. Le formulaire révisé contient le pied de page "Octobre 2014." Version annotée disponible.
Age:School Age
Language:French
Authorization to Release Information for Infants/Toddlers with Hearing Concerns cover image

Authorization to Release Information for Infants/Toddlers with Hearing Concerns

Effective Date:5/18/2020 1:46:13 PM
This is the Spanish version of the standard release form that will allow Early Intervention and the Department of Health to exchange information with a family of a child who is deaf or hard of hearing.
Age:Infant/Toddler
Language:Spanish
Authorization to Release Information for Infants/Toddlers with Hearing Concerns cover image

Authorization to Release Information for Infants/Toddlers with Hearing Concerns

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

Authorization to Release Information for Children in Early Intervention (Spanish)

Effective Date:5/4/2018 2:17:07 PM
This is the Spanish version of the standard release form used to obtain permission to share information with community agencies who are currently involved with local Early Intervention programs.
Age:Preschool,Infant/Toddler
Language:Spanish
Authorization to Release Information for Children in Early Intervention cover image

Authorization to Release Information for Children in Early Intervention

Effective Date:5/28/2018 1:00:00 AM
This standard release form is used to obtain permission to share information with community agencies who are currently involved with local Early Intervention programs.
Age:Infant/Toddler,Preschool
Language:English
Annotated Individualized Education Program with COVID-19 Guidance (Spanish) cover image

Annotated Individualized Education Program with COVID-19 Guidance (Spanish)

Effective Date:12/14/2020 3:39:48 PM
PROGRAMA DE EDUCACION INDIVIDUALIZADO (IEP, por sus siglas en inglés) (ANOTADA)This annotated document is effective December 14, 2020. It provides guidance on the development of the Individual Education Program; guidance related to school closures associated with COVID-19; and guidance pertaining to the October 2020 revision to Act 26 questions associated with postsecondary transition.
Age:School Age
Language:Spanish
Annotated Individualized Education Program (IEP) with COVID-19 Guidance cover image

Annotated Individualized Education Program (IEP) with COVID-19 Guidance

Effective Date:12/14/2020 2:41:40 PM
This annotated document provides guidance on the development of the Individual Education Program and includes guidance pertaining to the October 2020 revision to Act 26 related to postsecondary transition as well as any school closures as a result of COVID-19. Note: The annotated IEP was reformatted on June 14, 2021. Features were added to enhance navigation, search capabilities, and previewing individual sections. The content did not change. Users may select the “Interactive Annotated IEP with COVID-19 Guidance” or the “ADA Compliant Annotated IEP with COVID-19 Guidance.”
Age:School Age
Language:English
Annotated Individualized Education Program (IEP) cover image

Annotated Individualized Education Program (IEP)

Effective Date:2/1/2020 2:47:42 PM
This annotated document provides guidance on the development of the Individual Education Program and includes guidance pertaining to the October 2020 revision to Act 26 related to postsecondary transition. Note: The annotated IEP was reformatted on June 14, 2021. Features were added to enhance navigation, search capabilities, and previewing individual sections. The content did not change. Users may select the “Interactive Annotated IEP” or the “ADA Compliant Annotated IEP.”
Age:School Age
Language:English
AKÒ RENONSYASYON POU RE-EVALYASYON cover image

AKÒ RENONSYASYON POU RE-EVALYASYON

Effective Date:6/1/2008 1:31:52 PM
Agreement to Waive Re-evaluation (Haitian Creole)
Age:School Age
Language:Haitian Creole
Agreement to Waive Reevaluation -Annotated cover image

Agreement to Waive Reevaluation -Annotated

Effective Date:7/1/2018 8:41:03 AM
This annotated document describes the contents of the Agreement to Waive Reevaluation form, which is used by the LEA to obtain agreement from the parent to waive a child’s reevaluation. This document also replaces the September 2008 version and includes a change in terminology that replaces the term “mental retardation” with the term “intellectual disability.” This change aligns the Commonwealth’s special education regulations in Chapter 14 and Chapter 711 to the Individuals with Disabilities Education Act (IDEA) regulatory revisions resulting from Rosa’s Law. The change in terminology does not affect the meaning or the eligibility determination associated with the term.
Age:School Age
Language:English
Agreement to Waive Reevaluation (Italian) cover image

Agreement to Waive Reevaluation (Italian)

Effective Date:6/30/2008 11:00:00 PM
CONSENSO ALL’ESONERO DELLA RIVALUTAZIONE – This form is effective beginning July 1, 2008. This new form is used to obtain parental agreement to waiving a reevaluation. This request previously was included in the "Permission to Reevaluate/Agreement to Waive Reevaluation" form.
Age:School Age
Language:Italian
AGREEMENT TO WAIVE REEVALUATION - School Age cover image

AGREEMENT TO WAIVE REEVALUATION - School Age

Effective Date:6/30/2008 11:00:00 PM
This form is effective beginning July 1, 2008. This new form is used to obtain parental agreement to waiving a reevaluation. This request previously was included in the "Permission to Reevaluate/Agreement to Waive Reevaluation" form.
Age:School Age
Language:English
ACUERDO PARA RENUNCIAR A LA REVALUACIÓN - Edad escolar cover image

ACUERDO PARA RENUNCIAR A LA REVALUACIÓN - Edad escolar

Effective Date:1/1/0001 12:00:00 AM
AGREEMENT TO WAIVE REEVALUATION - School Age Este formulario entrará en vigor a partir del 1° de julio de 2008. Este nuevo formulario se utiliza para obtener el acuerdo de los padres a fin de descartar la reevaluación. Esta solicitud se incluyó previamente en el formulario "Permiso para reevaluar / Acuerdo para renunciar a la reevaluación". Versión con acotaciones disponible
Age:School Age
Language:Spanish
Act 26 Questions and Answers cover image

Act 26 Questions and Answers

Effective Date:1/1/0001 12:00:00 AM
Act 26 Questions and Answers
Age:
Language:English
ACCORD POUR RENONCER A LA REEVALUATION - Âge Scolaire cover image

ACCORD POUR RENONCER A LA REEVALUATION - Âge Scolaire

Effective Date:6/30/2008 11:00:00 PM
AGREEMENT TO WAIVE REEVALUATION - School Age Ce formulaire prend effet le 1er juillet 2008. Ce nouveau formulaire permet d'obtenir un accord parental pour renoncer à une réévaluation. Cette demande a déjà été incluse dans le formulaire «Autorisation de réévaluation/Accord de renonciation à la réévaluation». Version annotée disponible.
Age:School Age
Language:French
 Early Intervention Session Note – Spanish Version cover image

Early Intervention Session Note – Spanish Version

Effective Date:7/1/2023 1:19:30 PM
The standardized session note form is to be used by all Infant/Toddler Early Intervention programs. The session note reflects the Key Principles of Early Intervention in PA. It documents the provision of services and supports, assures communication with families or caregivers, and provides a mechanism to monitor the progress toward the Individualized Family Service Plan (IFSP) outcomes/goals.
Age:Infant/Toddler
Language:Spanish