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:3/10/2021 12:00:00 AM
Age:School Age
Language:Tagalog/Filapeno
Effective Date:12/1/2014 2:14:04 PM
This is the Portuguese version of the Procedural Safeguards Notice that 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:Portuguese
Effective Date:7/1/2018 12:00:00 AM
RAPPORT D'ÉVALUATION (ER) - Age scolaire
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:French
Effective Date:6/30/2008 11:00:00 PM
REEVALUATION REPORT (RR) - School Age
Questo modulo entra in vigore a partire dal 1 ° luglio 2008 e riflette le nuove disposizioni dei capitoli 14 e 711 rivisti. Questo nuovo Rapporto di Rivalutazione (con un piè di pagina che indica "revisioni Luglio 2008") sostituisce l'attuale Rapporto di Rivalutazione RR. Disponibile la Versione annotata
Age:School Age
Language:Italian
Effective Date:6/30/2008 11:00:00 PM
EVALUATION REPORT (ER) - School Age
Questo modulo entra in vigore a partire dal 1 luglio 2008 e considera le nuove disposizioni dei capitoli 14 e 711 rivisti. Questo nuovo Rapporto di Valutazione (con un piè di pagina che indica "revisioni di luglio 2008") sostituisce l'attuale ER. Disponibile la Versione annotata.
Age:School Age
Language:Italian
Effective Date:12/1/2022 12:00:00 AM
This revised Reevaluation Report (December 2022) replaces the July 2018 version and includes updated language. The updated language does not affect the process that local education agencies follow regarding the completion of the Reevaluation Report.
Age:School Age
Language:English
-July-30-2024.pdf?lang=en-us&ext=.pdf)
Effective Date:12/1/2022 12:00:00 AM
This annotated form describes the contents of the Reevaluation Report and includes updated language.
Age:School Age
Language:English
Effective Date:7/1/2018 8:46:04 AM
גיל בית הספר This revised Reevaluation 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:Hebrew
Effective Date:7/1/2018 8:41:03 AM
Evaluation Report-School Age
Este Reporte de Evaluación revisado en julio de 2018 reemplaza la versión de julio de 2008 e incluye un cambio en la terminología que sustituye el término "retraso mental" por el término "discapacidad intelectual". Este cambio también alinea las regulaciones de educación especial del estado de PA en los Capítulos 14 y 711 con las revisiones reglamentarias de la Ley de Educación para Individuos con Discapacidades (IDEA) que derivan de la ley Rosa’s Law. El cambio en la terminología no afecta el significado ni la determinación de elegibilidad asociada con el término.
Age:School Age
Language:Spanish
Effective Date:12/1/2016 11:00:00 PM
Reevaluation Report (Annotated)—School Age
Este formulario entra en vigor a partir del 1° de julio de 2008 y refleja las nuevas disposiciones de los Capítulos 14 y 711 revisados. Este nuevo Reporte de Reevaluación (con un pie de página que indica “Revisiones de julio de 2008”) reemplaza al Reporte de Reevaluación actual.
Age:School Age
Language:Spanish