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 31-40 of 419
Communication Plan for a Child Who Is Deaf or Hard of Hearing (Annotated) - School Age cover image

Communication Plan for a Child Who Is Deaf or Hard of Hearing (Annotated) - School Age

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
Complaint Resolution Process - Early Intervention  cover image

Complaint Resolution Process - Early Intervention

Effective Date:1/1/0001 12:00:00 AM
The Formal Complaint Form/Contact Information for (Infant Toddler and Preschool) is a form that parents can complete to request a formal complaint through the Bureau of Early Intervention Services.
Age:Infant/Toddler,Preschool
Language:English
CONSENSO GENITORIALE PER SCUSARE I MEMBRI DI PARTECIPARE ALL’ INCONTRO DELLA SQUADRA - ETÀ SCOLARE cover image

CONSENSO GENITORIALE PER SCUSARE I MEMBRI DI PARTECIPARE ALL’ INCONTRO DELLA SQUADRA - ETÀ SCOLARE

Effective Date:6/30/2008 11:00:00 PM
PARENTAL CONSENT TO EXCUSE MEMBERS FROM ATTENDING THE IEP TEAM MEETING - School Age Questo modulo entra in vigore a partire dal 1 ° luglio 2008 e riflette nuove disposizioni dei capitoli 14 e 711 rivisti. Questo nuovo invito (con un piè di pagina che indica "Revisioni di luglio 2008") sostituisce l'invito attuale. Questo invito non contiene più la richiesta di consenso dei genitori per scusare i membri della aquadra IEP di partecipare all’incontro della aquadra IEP. Questa richiesta è ora fatta con un modulo separato, "Consenso genitoriale per scusare i membri di partecipare all’ incontro della aquadra IEP". Disponibile la Versione annotata.
Age:School Age
Language:Italian
CONSENTIMIENTO DEL PADRE PARA EXCUSAR A UN MIEMBRO DEL EQUIPO DE ASISTIR A LA REUNIÓN DEL PROGRAMA DE EDUCACIÓN INDIVIDUALIZADO (IEP por sus siglas en inglés) - Edad escolar cover image

CONSENTIMIENTO DEL PADRE PARA EXCUSAR A UN MIEMBRO DEL EQUIPO DE ASISTIR A LA REUNIÓN DEL PROGRAMA DE EDUCACIÓN INDIVIDUALIZADO (IEP por sus siglas en inglés) - Edad escolar

Effective Date:6/30/2008 11:00:00 PM
PARENTAL CONSENT TO EXCUSE MEMBERS FROM ATTENDING THE IEP TEAM MEETING - School Age Este formulario entrará en vigor a partir del 1° de julio de 2008 y refleja las nuevas disposiciones de los Capítulos 14 y 711 revisados. Esta nueva Invitación (con un pie de página que indica “Revisiones de julio de 2008”) reemplaza a la Invitación actual. Esta Invitación ya no contiene la petición del consentimiento de los padres en cuanto a eximir a los miembros del equipo IEP de asistir a la reunión del equipo IEP. Esta petición ahora se hace con un formulario por separado, “Consentimiento de los Padres de Eximir a los Miembros de Asistir a la Reunión del Equipo IEP”. Versión con acotaciones disponible
Age:School Age
Language:Spanish
Early Intervention Session Note cover image

Early Intervention Session Note

Effective Date:7/1/2023 11:11:32 AM
This standardized session note form is to be used by all Infant/Toddler Early Intervention programs. The session note reflects the Key Principles of Early Intervention in PA. It documents the provision of services and supports, assures communication with families or caregivers, and provides a mechanism to monitor the progress toward the Individualized Family Service Plan (IFSP) outcomes/goals.
Age:Infant/Toddler
Language:English
Early Intervention Session Note - Annotated cover image

Early Intervention Session Note - Annotated

Effective Date:7/1/2023 11:13:55 AM
This document provides annotated guidance for using the Early Intervention session note form. The session note reflects the Key Principles of Early Intervention in PA. It documents the provision of services and supports, assures communication with families or caregivers, and provides a mechanism to monitor the progress toward the Individualized Family Service Plan (IFSP) outcomes/goals
Age:Infant/Toddler
Language:English
EINLADUNG ZUR TEILNAHME AM IEP TEAM MEETING ODER EINEM ANDEREN MEETING – Schulalter cover image

EINLADUNG ZUR TEILNAHME AM IEP TEAM MEETING ODER EINEM ANDEREN MEETING – Schulalter

Effective Date:6/14/2015 11:00:00 PM
INVITATION TO PARTICIPATE IN THE IEP TEAM MEETING OR OTHER MEETING Revidiert - Mai 2015 - Diese neue Einladung zur Teilnahme am IEP Team Meeting oder einem anderen Meeting (mit Fußzeile „Revisionen Mai 2015“) ersetzt die jetzige Einladung. Dieses revidierte Formular fügt ergänzende Bestimmungen für ein IEP Teammeeting zu, behebt die Anforderung zwei gesonderte Einladungen zur Teilnahme am IEP Teammeeting oder einem anderen Meeting über Übergangsplanung/-dienstleistungen zu verwenden, und ergänzt die Erklärungen für Übergangsplanung und -dienstleistungen, einschließlich einer Aussage, dass die Örtliche Schulbehörde (LEA) den Schüler einladen wird, wenn er/sie 14 oder älter ist. Dieses Formular ist gültig ab dem 30. Juni 2015.
Age:School Age
Language:German
ELTERLICHE ZUSTIMMUNG FÜR DAS ENTSCHULDIGTE FEHLEN VON MITGLIEDERN BEIM IEP TEAM MEETING – Schulalter cover image

ELTERLICHE ZUSTIMMUNG FÜR DAS ENTSCHULDIGTE FEHLEN VON MITGLIEDERN BEIM IEP TEAM MEETING – Schulalter

Effective Date:6/30/2008 11:00:00 PM
PARENTAL CONSENT TO EXCUSE MEMBERS FROM ATTENDING THE IEP TEAM MEETING Dieses Formular ist gültig ab dem 1. Juli 2008 und berücksichtigt neue Vorschriften der revidierten Kapitel 14 und 711. Diese neue Einladung (mit der Fußzeile „Revisionen Juli 2008“) ersetzt die jetzige Einladung. Diese Einladung beinhaltet nicht mehr den Antrag auf elterliche Zustimmung für das entschuldigte Fehlen von Mitgliedern des IEP Teams beim IEP Team Meeting. Dieser Antrag ist jetzt in einem gesonderten Formular - „Elterliche Zustimmung für das entschuldigte Fehlen von Mitgliedern beim IEP Team Meeting.“
Age:School Age
Language:German
Elterliche Zustimmung für die Berechnung des Pennsylvania Gesundheitsdiensts für Bedürftige  cover image

Elterliche Zustimmung für die Berechnung des Pennsylvania Gesundheitsdiensts für Bedürftige

Effective Date:3/17/2013 11:00:00 PM
Pennsylvania Medical Assistance Billing Parental Consent Die Elterliche Zustimmung für die Berechnung des PA Gesundheitsdiensts für Bedürftige ist gültig ab Oktober 2016. Dieses Formular ermöglicht Erziehungsberechtigten auszuwählen, ob sie der Örtlichen Schulbehörde (LEA, nach dem englischen Akronym) ihre Zustimmung geben, um den Gesundheitsdienst für Bedürftige für Sonderschuldienstleistungen zu berechnen.
Age:
Language:Polish
Evaluation Report  cover image

Evaluation Report

Effective Date:7/1/2018 8:41:03 AM
This revised Evaluation Report (July 2018) replaces the July 2008 version and 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.
Age:School Age
Language:English