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: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
Effective Date:9/30/2016 11:00:00 PM
This notice informs parents of their rights regarding consent for accessing benefits and insurance to pay for services under the Individuals with Disabilities Education Act (IDEA). 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. Spanish Version
Age:Preschool
Language:Spanish
Effective Date:10/31/2017 11:00:00 PM
The PA Medical Assistance Billing Parental Notice is effective beginning October 2016. This notice informs parents of their rights regarding consent for accessing benefits and insurance to pay for services under the Individuals with Disabilities Education Act (IDEA). Spanish Version.
Age:Infant/Toddler,Preschool
Language:Spanish
Effective Date:11/11/2017 2:47:25 PM
This form allows parents to choose whether to give consent to access reimbursement from Medical Assistance for Early Intervention/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:Infant/Toddler,Preschool
Language:Vietnamese
Effective Date:6/8/2021 12:48:42 PM
This form is effective beginning June 8, 2021. This document must be issued by the Local Education Agency in response to a parent's oral request for an evaluation within 10 calendar days of the oral request.
Age:School Age
Language:English
Effective Date:6/8/2021 12:51:17 PM
This annotated document describes the contents of the Permission to Evaluate - Oral Request Form, which is provided to the parent by the LEA upon a parent’s oral request for an evaluation. This form provides the means of documenting the parental request in writing.
Age:School Age
Language:English
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
Effective Date:2/1/2014 9:58:20 AM
Spanish Version of the Preschool Early Intervention Permission to Evaluate form. This form must be issued by the Local Education Agency to obtain written consent to conduct an initial evaluation.
Age:Preschool
Language:Spanish
Effective Date:3/30/2014 9:24:13 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:Albanian
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