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 51-60 of 76
Pennsylvania Medical Assistance Billing Parental Notice  cover image

Pennsylvania Medical Assistance Billing Parental Notice

Effective Date:11/1/2017 12:00:00 AM
This form allows parents to choose whether to give consent for the Local Educational Agency (LEA) to access reimbursement from Medical Assistance for special education services. This form offers assistance and guidance to parents and early intervention providers. It is not intended as an exclusive manner for complying with state and/or federal special education statutes and regulations.
Age:Preschool,Infant/Toddler
Language:English
Pennsylvania Medical Assistance Billing Parental Notice - Annotated cover image

Pennsylvania Medical Assistance Billing Parental Notice - Annotated

Effective Date:11/1/2017 12:00:00 AM
This is an annotated version of the Medical Assistance Billing Parental Notice form which provides notice to parents on giving consent for the Local Educational Agency (LEA) to access reimbursement from Medical Assistance for special education services. This annotation offers guidance to Early Intervention staff. It is not intended as an exclusive manner for complying with state and/or federal special education statutes and regulations.
Age:Infant/Toddler,Preschool
Language:English
PERMISSION TO EVALUATE - Preschool Early Intervention cover image

PERMISSION TO EVALUATE - Preschool Early Intervention

Effective Date:1/1/0001 12:00:00 AM
This form is effective beginning March 2014. This form must be issued by the Local Education Agency to obtain written consent to conduct an initial evaluation.
Age:Preschool
Language:English
Permission to Evaluate (Annotated) - Preschool Early Intervention cover image

Permission to Evaluate (Annotated) - Preschool Early Intervention

Effective Date:1/1/0001 12:00:00 AM
This form is effective beginning March 2014. This form must be issued by the Local Education Agency to obtain written consent to conduct an initial evaluation. This is the annotated version. This annotated form offers assistance and guidance to parents and early intervention providers. It is not intended as an exclusive manner for complying with state and/or federal special education statutes and regulations.
Age:Preschool
Language:English
PERMISSION TO REEVALUATE  - Preschool Early Intervention  cover image

PERMISSION TO REEVALUATE - Preschool Early Intervention

Effective Date:1/1/0001 12:00:00 AM
This form is effective beginning March 2014. This form must be issued by the Local Education Agency to obtain written consent to conduct a reevaluation.
Age:Preschool
Language:English
Permission to Reevaluate (Annotated) - Preschool Early Intervention  cover image

Permission to Reevaluate (Annotated) - Preschool Early Intervention

Effective Date:1/1/0001 12:00:00 AM
This form is effective beginning March 2014. This form must be issued by the Local Education Agency to obtain written consent to conduct a reevaluation.This annotated form offers assistance and guidance to parents and early intervention providers. 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 Early Intervention Evaluation Report  cover image

Preschool Early Intervention Evaluation Report

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.
Age:Preschool
Language:English
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