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.
IEP in Braille
Download the Nemeth format ⏷
Download the UEB format ⏷
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
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
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
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
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
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
Effective Date:7/2/2008 12:00:00 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:Italian
Effective Date:7/2/2008 12:00:00 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:Russian
Effective Date:7/2/2008 12:00:00 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:Spanish
Effective Date:12/1/2010 12:00:00 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:Ukranian