Forms

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

Results 11-20 of 87
Communication Plan for a Child Who Is Deaf or Hard of Hearing (Annotated) - School Age cover image

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

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

Due Process Complaint Notice - Preschool Early Intervention

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

Early Intervention Session Note Form

Effective Date:1/1/0001 12:00:00 AM
This standardized session note form is to be used by all Infant/Toddler Early Intervention programs. The session note form documents the provision of services and supports, assures communication with families/caregivers and provides a mechanism to monitor the quality of services. Updated March 2013.
Age:Infant/Toddler
Language:English
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
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
Individualized Education Program (IEP) cover image

Individualized Education Program (IEP)

Effective Date:7/1/2018 8:41:03 AM
Revised IEP July 2018 – This revised form (with footer July 2018) provides updated changes and clarification regarding student participation in state and local assessments including updated eligibility requirements for students who participate in the PASA alternate assessment. In addition, there are changes in terminology that replace English Language Learners with English Learners. Lastly, there are updated website references throughout the document.
Age:School Age
Language:English
Individualized Education Program (IEP) - Early Intervention Annotated cover image

Individualized Education Program (IEP) - Early Intervention Annotated

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

INDIVIDUALIZED EDUCATION PROGRAM (IEP) (ANNOTATED)

Effective Date:7/1/2018 8:41:03 AM
This revised annotated form (with footer July 2018) provides updated Federal legislation replacing No Child Left Behind with Every Student Succeeds Act. There are also changes and clarification regarding student participation in state and local assessments including updated eligibility requirements for students who participate in the PASA alternate assessment. In addition, there are changes in terminology that replace the term mental retardation with the term intellectual disability, English Language Learners with English Learners, and students with Limited English Proficiency with English Learners. Lastly, there are updated website references throughout the document.
Age:School Age
Language:English
Individualized Family Service Plan (IFSP) - Early Intervention Annotated cover image

Individualized Family Service Plan (IFSP) - Early Intervention Annotated

Effective Date:12/1/2018 12:00:00 AM
Infant Toddler Early Intervention plan document for use as of December 2018. The IFSP and IEP are plans that identify services and supports for children and families involved in Early Intervention. The IFSP and IEP consider the strengths of the child; concerns of the parent/guardian and most recent evaluation results so that family members and early education programs are actively engaged in promoting the child’s learning and development. This annotated form provides guidance to parents and early intervention staff completing the evaluation report. It is not intended as an exclusive manner for complying with state and/or federal special education statutes and regulations.
Age:Infant/Toddler
Language:English