Forms

The Procedural Safeguards Notice includes a full explanation of rights available to parents of a school age child with a disability when their child has been referred for or is receiving special education services. This model form provides a format that LEAs may choose to use to provide information about procedural safeguards to parents. This revised Procedural Safeguards Notice includes updated contact information and the Bureau of Special Education Complaint Information Packet and Form.

The Procedural Safeguards Notice includes a full explanation of rights available to parents of a school age child with a disability when their child has been referred for or is receiving special education services. This model form provides a format that LEAs may choose to use to provide information about procedural safeguards to parents. This revised Procedural Safeguards Notice includes updated contact information and the Bureau of Special Education Complaint Information Packet and Form.

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.

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.

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.

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.”

The Procedural Safeguards Notice includes a full explanation of rights available to parents of a school age child with a disability when their child has been referred for or is receiving special education services. This model form provides a format that LEAs may choose to use to provide information about procedural safeguards to parents. This revised Procedural Safeguards Notice includes updated contact information and the Bureau of Special Education Complaint Information Packet and Form. Effective Date: April 28, 2025 Age: School Age Language: Arabic

The Procedural Safeguards Notice includes a full explanation of rights available to parents of a school age child with a disability when their child has been referred for or is receiving special education services. This model form provides a format that LEAs may choose to use to provide information about procedural safeguards to parents. This revised Procedural Safeguards Notice includes updated contact information and the Bureau of Special Education Complaint Information Packet and Form. Effective Date: April 28, 2025 Age: School Age Language: Chinese

The Procedural Safeguards Notice includes a full explanation of rights available to parents of a school age child with a disability when their child has been referred for or is receiving special education services. This model form provides a format that LEAs may choose to use to provide information about procedural safeguards to parents. This revised Procedural Safeguards Notice includes updated contact information and the Bureau of Special Education Complaint Information Packet and Form. Effective Date: April 28, 2025 Age: School Age Language: French

કાર્યપદ્ધતિની સલામતિઓની સૂચના The Procedural Safeguards Notice includes a full explanation of all the rights available to parents of a child with a disability ages 3-21 when their child has been referred for or is receiving special education services. This model form provides a format that LEAs may choose to use to provide information about procedural safeguards to parents. This revised Procedural Safeguards Notice includes a change in terminology that replaces the term “mental retardation” with the term “intellectual disability.” This change also aligns the Commonwealth’s special education regulations in Chapters 14 and 711 to the Individuals with Disabilities Education Act (IDEA) regulatory revisions resulting from Rosa’s Law. The change in terminology does not affect the meaning or the eligibility determination associated with the term. Also, this revised notice includes additional resources for parents in Appendix A. In addition, this document contains a revised Office for Dispute Resolution (ODR) Request Form for IEP/IFSP/GIEP Facilitation, Mediation, and a revised Due Process Compliant Request Form in Appendix B. The revised Procedural Safeguards Notice contains the footer “July 2018.” This notice is available in two formats - a Word document and a pdf. Below is the request form for Mediation, IEP/IFSP/GIEP Facilitation and the Due Process Complaint form. The form can be submitted via mail, fax or email; contact information can be found at the bottom of each form. Requests can also be submitted via the online submission form on ODR’s website.