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 201-210 of 318
Procedural Safeguards Letter - Preschool Early Intervention Russian cover image

Procedural Safeguards Letter - Preschool Early Intervention Russian

Effective Date:11/30/2014 11:00:00 PM
Letter to a parent on their rights and their child’s rights related to early intervention services Russian version.
Age:Preschool
Language:Russian
Procedural Safeguards Letter - Preschool Early Intervention Russian cover image

Procedural Safeguards Letter - Preschool Early Intervention Russian

Effective Date:11/30/2014 11:00:00 PM
Letter to a parent on their rights and their child’s rights related to early intervention services Russian version.
Age:Preschool
Language:Russian
Procedural Safeguards Letter - Preschool Early Intervention Spanish cover image

Procedural Safeguards Letter - Preschool Early Intervention Spanish

Effective Date:11/30/2014 11:00:00 PM
Letter to a parent on their rights and their child’s rights related to early intervention services Spanish version.
Age:Preschool
Language:Spanish
Procedural Safeguards Letter - Preschool Early Intervention Ukranian cover image

Procedural Safeguards Letter - Preschool Early Intervention Ukranian

Effective Date:11/30/2014 11:00:00 PM
Letter to a parent on their rights and their child’s rights related to early intervention services Ukranian version.
Age:Preschool
Language:Ukranian
Procedural Safeguards Letter - Preschool Early Intervention Urdu cover image

Procedural Safeguards Letter - Preschool Early Intervention Urdu

Effective Date:11/30/2014 11:00:00 PM
Letter to a parent on their rights and their child’s rights related to early intervention services Urdu version.
Age:Preschool
Language:Urdu
Procedural Safeguards Letter - Preschool Early Intervention Vietnamese cover image

Procedural Safeguards Letter - Preschool Early Intervention Vietnamese

Effective Date:11/30/2014 11:00:00 PM
Letter to a parent on their rights and their child’s rights related to early intervention services Vietnamese version.
Age:Preschool
Language:Vietnamese
Procedural Safeguards Letter (Gujarati) cover image

Procedural Safeguards Letter (Gujarati)

Effective Date:7/1/2018 12:28:12 PM
કાર્યપદ્ધતિની સલામતીઓનો પત્ર This revised Procedural Safeguards Letter (with a footer indicating “July 2018 Revisions”) replaces the current Procedural Safeguards Letter dated July 1, 2008. This revised letter 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 Chapter 14 to the Individuals with Disabilities Education Act (IDEA) regulatory revisions resulting from Rosa’s Law. There are no other changes to the current regulations in Chapter 14 or 711.
Age:School Age
Language:Gujarati
Procedural Safeguards Letter (Hatian Creole) cover image

Procedural Safeguards Letter (Hatian Creole)

Effective Date:7/1/2018 3:17:48 PM
LÈT GARANTI SOU PWOSEDI YO
Age:School Age
Language:Haitian Creole
Procedural Safeguards Letter (Hebrew) cover image

Procedural Safeguards Letter (Hebrew)

Effective Date:7/1/2018 9:37:46 AM
מכתב אמצעי ביטחון פרוצדורליים This revised Procedural Safeguards Letter (with a footer indicating “July 2018 Revisions”) replaces the current Procedural Safeguards Letter dated July 1, 2008. This revised letter 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 Chapter 14 to the Individuals with Disabilities Education Act (IDEA) regulatory revisions resulting from Rosa’s Law. There are no other changes to the current regulations in Chapter 14 or 711.
Age:School Age
Language:Hebrew
Procedural Safeguards Notice  cover image

Procedural Safeguards Notice

Effective Date:7/1/2018 8:41:03 AM
The Procedural Safeguards Notice includes a full explanation of all the rights available to parents of a child with a disability ages 3-21 when their child has been referred for or is receiving special education services. This model form provides a format that LEAs may choose to use to provide information about procedural safeguards to parents. This revised Procedural Safeguards Notice 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. Also, this revised notice includes additional resources for parents in Appendix A. In addition, this document contains a revised Office for Dispute Resolution (ODR) Request Form for IEP/IFSP/GIEP Facilitation, Mediation, and a revised Due Process Compliant Request Form in Appendix B. The revised Procedural Safeguards Notice contains the footer “July 2018.” This notice is available in two formats - a Word document and a pdf. Below is the request form for Mediation, IEP/IFSP/GIEP Facilitation and the Due Process Complaint form. The form can be submitted via mail, fax or email; contact information can be found at the bottom of each form. Requests can also be submitted via the online submission form on ODR’s website. Mediation & IEP/IFSP/GIEP Facilitation Request (English) - http://odr-pa.org/iep-ifsp-med-request-form-english/ Mediation & IEP/IFSP/GIEP Facilitation (Spanish) – http://odr-pa.org/mediation-iep-online-request-spanish/ Due Process Complaint (English) - http://odr-pa.org/due-process-online-request/ Due Process Complaint (Spanish) - http://odr-pa.org/due-process-online-request-spanish/ *Note: The online submission forms can be accessed in 11 other languages via the ODR website. They include Albanian, Arabic, Chinese Simplified, Chinese Traditional, French, German, Italian, Japanese, Korean, Russian and Portuguese.
Age:School Age
Language:English