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 11-20 of 435
AKÒ RENONSYASYON POU RE-EVALYASYON cover image

AKÒ RENONSYASYON POU RE-EVALYASYON

Effective Date:6/1/2008 1:31:52 PM
Agreement to Waive Re-evaluation (Haitian Creole)
Age:School Age
Language:Haitian Creole
Annotated Individualized Education Program (IEP) cover image

Annotated Individualized Education Program (IEP)

Effective Date:2/1/2020 2:47:42 PM
This annotated document provides guidance on the development of the Individual Education Program and includes guidance pertaining to the October 2020 revision to Act 26 related to postsecondary transition. Note: The annotated IEP was reformatted on June 14, 2021. Features were added to enhance navigation, search capabilities, and previewing individual sections. The content did not change. Users may select the “Interactive Annotated IEP” or the “ADA Compliant Annotated IEP.”
Age:School Age
Language:English
Annotated Individualized Education Program (IEP) with COVID-19 Guidance cover image

Annotated Individualized Education Program (IEP) with COVID-19 Guidance

Effective Date:12/14/2020 2:41:40 PM
This annotated document provides guidance on the development of the Individual Education Program and includes guidance pertaining to the October 2020 revision to Act 26 related to postsecondary transition as well as any school closures as a result of COVID-19. Note: The annotated IEP was reformatted on June 14, 2021. Features were added to enhance navigation, search capabilities, and previewing individual sections. The content did not change. Users may select the “Interactive Annotated IEP with COVID-19 Guidance” or the “ADA Compliant Annotated IEP with COVID-19 Guidance.”
Age:School Age
Language:English
Annotated Individualized Education Program with COVID-19 Guidance (Spanish) cover image

Annotated Individualized Education Program with COVID-19 Guidance (Spanish)

Effective Date:12/14/2020 3:39:48 PM
PROGRAMA DE EDUCACION INDIVIDUALIZADO (IEP, por sus siglas en inglés) (ANOTADA)This annotated document is effective December 14, 2020. It provides guidance on the development of the Individual Education Program; guidance related to school closures associated with COVID-19; and guidance pertaining to the October 2020 revision to Act 26 questions associated with postsecondary transition.
Age:School Age
Language:Spanish
Authorization to Release Information for Children in Early Intervention cover image

Authorization to Release Information for Children in Early Intervention

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
Authorization to Release Information for Children in Early Intervention (Spanish) cover image

Authorization to Release Information for Children in Early Intervention (Spanish)

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
Authorization to Release Information for Infants/Toddlers with Hearing Concerns cover image

Authorization to Release Information for Infants/Toddlers with Hearing Concerns

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
Authorization to Release Information for Infants/Toddlers with Hearing Concerns cover image

Authorization to Release Information for Infants/Toddlers with Hearing Concerns

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
AVIS DE PLACEMENT SCOLAIRE RECOMMANDE / PREAVIS ECRIT (NOREP/PWN) - Âge Scolaire cover image

AVIS DE PLACEMENT SCOLAIRE RECOMMANDE / PREAVIS ECRIT (NOREP/PWN) - Âge Scolaire

Effective Date:11/16/2014 11:00:00 PM
NOTICE OF RECOMMENDED EDUCATIONAL PLACEMENT/PRIOR WRITTEN NOTICE (NOREP/PWN) - School Age Ce formulaire NOREP/PWN offre un format que les LEA peuvent choisir de communiquer aux parents le programme éducatif recommandé pour leur enfant et d'autres mesures prises par l’ LEA. Ce NOREP/PWN révisé comprend des ressources supplémentaires pour les parents à la page 4. Le formulaire révisé contient le pied de page "Octobre 2014." Version annotée disponible.
Age:School Age
Language:French
AVISO DE GARANTÍAS DE PROCEDIMIENTO cover image

AVISO DE GARANTÍAS DE PROCEDIMIENTO

Effective Date:7/1/2018 8:41:03 AM
Procedural Safeguards Notice-School Age El Aviso de garantías procesales incluye una explicación completa de todos los derechos disponibles para los padres de un niño con una discapacidad de 3 a 21 años de edad cuando su hijo ha sido referido o está recibiendo servicios de educación especial. Este formulario de modelo proporciona un formato que las Agencias de Educación Locales pueden elegir para proveer a los padres información sobre las garantías procesales. Este Aviso de garantías procesales revisado 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 en los Capítulos 14 y 711 con las revisiones reglamentarias de la Ley de Educación para Personas con Discapacidades (IDEA, por sus siglas en inglés) que resultan de la Ley de Rosa. El cambio en la terminología no afecta el significado o la determinación de elegibilidad asociada con el término. Además, este aviso revisado incluye recursos adicionales para los padres en el Apéndice A. Además, este documento contiene un Formulario de solicitud revisado de la Oficina de Resolución de Disputas (ODR) para la facilitación, la mediación del IEP / IFSP / GIEP y un formulario de solicitud revisado que cumple con el debido proceso en el Apéndice B. El Aviso de garantías procesales revisado contiene el pie de página "Julio de 2018". Este formulario está disponible en dos formatos: un documento de Word y un pdf. A continuación se encuentra el formulario de solicitud de Mediación, Facilitación IEP / IFSP / GIEP y el formulario de quejas de Debido Proceso. El formulario puede ser enviado por correo, fax o correo electrónico; la información de contacto se puede encontrar en la parte inferior de cada formulario. Las solicitudes también se pueden enviar a través del formulario de envío en línea en el sitio web de la ODR. Mediación y solicitud de facilitación IEP / IFSP / GIEP (inglés) - http://odr-pa.org/iep-ifsp-med-request-form-english/ Mediación y Facilitación IEP / IFSP / GIEP (en español) - http://odr-pa.org/mediation-iep-online-request-spanish/ Queja de debido proceso (en inglés) - http://odr-pa.org/due-process-online-request/ Queja de debido proceso (en español) - http://odr-pa.org/due-process-online-request-spanish/ *Nota: Se puede acceder a los formularios de presentación en línea en otros 11 idiomas a través del sitio web de la ODR. Incluyen albanés, árabe, chino simplificado, chino tradicional, francés, alemán, italiano, japonés, coreano, ruso y portugués.
Age:School Age
Language:Spanish