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.
Effective Date:7/1/2018 10:17:14 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:Indonesian
Effective Date:4/28/2025 11:23:44 AM
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.
Age:School Age
Language:English
Effective Date:1/1/0001 12:00:00 AM
Chinese version of the Procedural Safeguards Notice used by Early Intervention Preschool Programs. This form was revised in July of 2008.
Age:Preschool
Language:Chinese
Effective Date:1/1/0001 12:00:00 AM
Korean version of the Procedural Safeguards Notice used by Early Intervention Preschool Programs. This form was revised in July of 2008.
Age:Preschool
Language:Korean
Effective Date:
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.
Age:Preschool
Language:French
Effective Date:6/15/2022 8:25:35 AM
Procedural Safeguards Notice translated to Haitian Creole
Age:School Age
Language:Haitian Creole
Effective Date:6/1/2009 12:00:00 AM
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.
Age:School Age
Language:Polish
Effective Date:1/31/2025 1:00:00 AM
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.
Age:Preschool
Language:English
Effective Date:1/1/0001 12:00:00 AM
Arabic Version of the Procedural Safeguards Notice - Preschool Early Intervention.
Age:Preschool
Language:Arabic
Effective Date:11/30/2014 11:00:00 PM
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. Japanese Version.
Age:Preschool
Language:Japanese