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.
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Effective Date:7/1/2018 1:20:41 PM
بيان حماية الإجراءات Procedural Safeguards Notice - Arabic Version
Age:School Age
Language:Arabic
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:6/15/2022 8:25:35 AM
Procedural Safeguards Notice translated to Haitian Creole
Age:School Age
Language:Haitian Creole
Effective Date:12/1/2014 12:00:00 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
Effective Date:12/1/2014 1:41:16 PM
This is the Nepali Version of the Procedural Safeguards Notice, the letter explaining to a parent their rights and their child’s rights related to Early Intervention services.
Age:Preschool
Language:Nepali
Effective Date:1/1/0001 12:00:00 AM
Russian Version of the Procedural Safeguards Notice - Preschool Early Intervention.
Age:Preschool
Language:Russian
Effective Date:1/1/0001 12:00:00 AM
Spanish Version of the Procedural Safeguards Notice - Preschool Early Intervention - Spanish VERSION.
Age:Preschool
Language:Spanish