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 485
EVALUATION REPORT (ER) - School Age (Vietnamese) cover image

EVALUATION REPORT (ER) - School Age (Vietnamese)

Effective Date:7/1/2018 12:00:00 AM
BÁO CÁO ĐÁNH GIÁ (BCĐG) - Độ tuổi đến trường 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:Vietnamese
Carta de las Garantías Procesales cover image

Carta de las Garantías Procesales

Effective Date:7/1/2018 8:41:03 AM
Procedural Safeguards Letter--School Age Esta Carta de las Garantías procesales revisada (con un pie de página que indica “Revisiones hechas en julio de 2008”) reemplaza a la Carta de Salvaguardias Procesales con fecha del 1° de julio de 2008. Esta carta revisada incluye un cambio en la terminología que reemplaza el término "retraso mental" por el término "discapacidad intelectual". Este cambio también alinea las regulaciones de educación especial del estado de PA que aparecen en el Capítulo 14 con las revisiones reglamentarias de la Ley de Educación para Individuos con Discapacidades (IDEA) que derivan de la ley Rosa’s Law. No hay ningún otro cambio en las regulaciones actuales del Capítulo 14 o del 711.
Age:School Age
Language:Spanish
CHẤP THUẬN CỦA CHA MẸ XIN LỖI CÁC THÀNH VIÊN KHÔNG THAM DỰ CUỘC HỌP NHÓM IEP - Độ tuổi đến trường cover image

CHẤP THUẬN CỦA CHA MẸ XIN LỖI CÁC THÀNH VIÊN KHÔNG THAM DỰ CUỘC HỌP NHÓM IEP - Độ tuổi đến trường

Effective Date:6/30/2008 11:00:00 PM
PARENTAL CONSENT TO EXCUSE MEMBERS FROM ATTENDING THE IEP TEAM MEETING - School Age Biểu mẫu này có hiệu lực từ ngày 1 tháng 7 năm 2008 và phản ánh những điều khoản mới của các Chương sửa đổi số 14 và 711. Thư mời mới này (với phần chú thích trang ghi "Sửa đổi tháng 7 năm 2008”) thay thế cho Thư mời hiện thời. Thư mời này không bao gồm yêu cầu có sự chấp thuận của cha mẹ xin lỗi các thành viên nhóm IEP không tham dự cuộc họp nhóm IEP. Yêu cầu này được lập bằng biểu mẫu riêng, "Chấp thuận của Cha mẹ Xin lỗi các Thành viên Không tham dự Họp Nhóm IEP.” Bản chú giải có sẵn
Age:School Age
Language:Vietnamese
Communication Plan for a Child Who Is Deaf or Hard of Hearing cover image

Communication Plan for a Child Who Is Deaf or Hard of Hearing

Effective Date:10/14/2022 9:27:02 AM
The Communication Plan must be included in the IEP of any student who is deaf or hard of hearing. The Communication Plan form was revised July 2022. At that time changes were made in Sections l, lll, and IV. Sections have been reduced to Sections l and Section ll. Section l: Language and Communication Needs, includes a sign-in area for contributors, asks for data to support conclusions and includes a chart to address primary language and communication mode. Section lll has updated the language for assistive technology, devices, and services. Section lll requires the team to examine if the student has appropriate academic language and communication skills to participate in and access curriculum and instruction. Section lV, Full Range of Needs, has been made into a question thus requiring more discussion. Glossary terms have also been added, revised or deleted as appropriate. The revised plan has a footer reading October 14, 2022. Annotated version available
Age:School Age
Language:English
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