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 61-70 of 79
Preschool Early Intervention Evaluation Report – Annotated cover image

Preschool Early Intervention Evaluation Report – Annotated

Effective Date:12/1/2018 12:00:00 AM
Early Intervention Evaluation Report for use as of December 2018. The Evaluation Report documents information on a child and family, including strengths and needs, provides eligibility determinations, and provides recommendations for supports that can assist the young child to develop, learn and grow. 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:Preschool
Language:English
Preschool to School Age Transition Considerations for Children who are Deaf, Hard of Hearing or Deaf-Blind cover image

Preschool to School Age Transition Considerations for Children who are Deaf, Hard of Hearing or Deaf-Blind

Effective Date:10/31/2015 11:00:00 PM
Preschool to School Age Transition Considerations for Children who are Deaf, Hard of Hearing or Deaf-Blind
Age:School Age
Language:English
Prior Written Notice for Initial Evaluation and Request for Consent Form - School Age cover image

Prior Written Notice for Initial Evaluation and Request for Consent Form - School Age

Effective Date:3/29/2015 11:00:00 PM
This new form is effective beginning March 30, 2015 and reflects the requirement that initial evaluations are subject to the IDEA’s notice requirements in 34 CFR Sec. 300.503-300.504, and parental consent requirements in 34 CFR Sec. 300.300. Under 34 CFR Sec. 300.503(a) the local education agency (LEA) must provide written notice to the parents of a child with a disability that describes any evaluation procedures the agency proposes to conduct, and must be given to the parents of a child with a disability a reasonable time before the public agency: (1) Proposes to initiate or change the identification, evaluation or educational placement of the child or the provision of a free appropriate public education (FAPE) to the child; or (2) Refuses to initiate or change the identification, evaluation or educational placement of the child or the provision of FAPE to the child. This Prior Written Notice for Initial Evaluation and Request for Consent Form includes the notice and consent requirements for the initial evaluation. This form replaces the Permission to Evaluate – Consent Form. It contains the footer, “Revised January 2015.”
Age:School Age
Language:English
Prior Written Notice for Initial Evaluation and Request for Consent Form (Annotated) - School Age cover image

Prior Written Notice for Initial Evaluation and Request for Consent Form (Annotated) - School Age

Effective Date:3/29/2015 11:00:00 PM
This annotated document describes the new Prior Written Notice for Initial Evaluation and Request for Consent Form, which reflects the requirement that initial evaluations are subject to the IDEA’s notice requirements in 34 CFR Sec. 300.503-300.504, and parental consent requirements in 34 CFR Sec. 300.300. Under 34 CFR Sec. 300.503(a) the local education agency (LEA) must provide written notice to the parents of a child with a disability that describes any evaluation procedures the agency proposes to conduct, and must be given to the parents of a child with a disability a reasonable time before the public agency: (1) Proposes to initiate or change the identification, evaluation or educational placement of the child or the provision of a free appropriate public education (FAPE) to the child; or (2) Refuses to initiate or change the identification, evaluation or educational placement of the child or the provision of FAPE to the child. This Prior Written Notice for Initial Evaluation and Request for Consent Form includes the notice and consent requirements for initial evaluation. This form replaces the Permission to Evaluate – Consent Form (Annotated). It contains the footer, “Revised January 2015.” This new form is effective beginning March 30, 2015.
Age:School Age
Language:English
Prior Written Notice for Reevaluation and Request for Consent Form - School Age cover image

Prior Written Notice for Reevaluation and Request for Consent Form - School Age

Effective Date:3/29/2015 11:00:00 PM
This new form is effective beginning March 30, 2015 and reflects the requirement that reevaluations are subject to the IDEA’s notice requirements in 34 CFR Sec. 300.503-300.504, and parental consent requirements in 34 CFR Sec. 300.300. Under 34 CFR Sec. 300.503(a) the local education agency (LEA) must provide written notice to the parents of a child with a disability that describes any reevaluation procedures the agency proposes to conduct, and must be given to the parents of a child with a disability a reasonable time before the public agency: (1) Proposes to initiate or change the identification, evaluation or educational placement of the child or the provision of a free appropriate public education (FAPE) to the child; or (2) Refuses to initiate or change the identification, evaluation or educational placement of the child or the provision of FAPE to the child. This Prior Written Notice for Reevaluation and Request for Consent Form includes the notice and consent requirements for the reevaluation. This form replaces the Permission to Reevaluate – Consent Form. It contains the footer, “Revised January 2015.”
Age:School Age
Language:English
Prior Written Notice for Reevaluation and Request for Consent Form (Annotated) - School Age cover image

Prior Written Notice for Reevaluation and Request for Consent Form (Annotated) - School Age

Effective Date:3/29/2015 11:00:00 PM
This annotated document describes the new Prior Written Notice for Reevaluation and Request for Consent Form, which reflects the requirement that reevaluations are subject to the IDEA’s notice requirements in 34 CFR Sec. 300.503-300.504, and parental consent requirements in 34 CFR Sec. 300.300. Under 34 CFR Sec. 300.503(a) the local education agency (LEA) must provide written notice to the parents of a child with a disability that describes any reevaluation procedures the agency proposes to conduct, and must be given to the parents of a child with a disability a reasonable time before the public agency: (1) Proposes to initiate or change the identification, evaluation or educational placement of the child or the provision of a free appropriate public education (FAPE) to the child; or (2) Refuses to initiate or change the identification, evaluation or educational placement of the child or the provision of FAPE to the child. This Prior Written Notice for Reevaluation and Request for Consent Form includes the notice and consent requirements for the reevaluation. This form replaces the Permission to Reevaluate – Consent Form (Annotated). It contains the footer, “Revised January 2015.” This new form is effective beginning March 30, 2015.
Age:School Age
Language:English
Procedural Safeguards Letter  cover image

Procedural Safeguards Letter

Effective Date:7/1/2018 8:41:03 AM
This revised Procedural Safeguards Letter (with a footer indicating “July 2018 Revisions”) replaces the current Procedural Safeguards Letter dated July 1, 2008. This revised letter 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 Chapter 14 to the Individuals with Disabilities Education Act (IDEA) regulatory revisions resulting from Rosa’s Law. There are no other changes to the current regulations in Chapter 14 or 711.
Age:School Age
Language:English
Procedural Safeguards Letter – Early Intervention cover image

Procedural Safeguards Letter – Early Intervention

Effective Date:12/1/2014 12:00:00 AM
Letter to a parent on their rights and their child’s rights related to Early Intervention services.
Age:Preschool
Language:English
Procedural Safeguards Letter - Preschool Early Intervention  cover image

Procedural Safeguards Letter - Preschool Early Intervention

Effective Date:11/30/2014 11:00:00 PM
Letter to a parent on their rights and their child’s rights related to early intervention services.
Age:Preschool
Language:English
PROCEDURAL SAFEGUARDS LETTER - school age  cover image

PROCEDURAL SAFEGUARDS LETTER - school age

Effective Date:6/30/2008 11:00:00 PM
This form is effective beginning July 1, 2008 and reflects new provisions of revised Chapters 14 and 711. This new Procedural Safeguards Letter (with a footer indicating "July 2008 Revisions") replaces the current Procedural Safeguards Letter.
Age:School Age
Language:English