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 21-30 of 365
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
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
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
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
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
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
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
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
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
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