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.

Results 1-10 of 85
Act 26 Questions and Answers cover image

Act 26 Questions and Answers

Effective Date:1/1/0001 12:00:00 AM
Act 26 Questions and Answers
Age:
Language:English
AGREEMENT TO WAIVE REEVALUATION - School Age cover image

AGREEMENT TO WAIVE REEVALUATION - School Age

Effective Date:6/30/2008 11:00:00 PM
This form is effective beginning July 1, 2008. This new form is used to obtain parental agreement to waiving a reevaluation. This request previously was included in the "Permission to Reevaluate/Agreement to Waive Reevaluation" form.
Age:School Age
Language:English
Agreement to Waive Reevaluation -Annotated cover image

Agreement to Waive Reevaluation -Annotated

Effective Date:7/1/2018 8:41:03 AM
This annotated document describes the contents of the Agreement to Waive Reevaluation form, which is used by the LEA to obtain agreement from the parent to waive a child’s reevaluation. This document also replaces the September 2008 version and includes a change in terminology that replaces the term “mental retardation” with the term “intellectual disability.” This change aligns the Commonwealth’s special education regulations in Chapter 14 and Chapter 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:English
Annotated Guidance for Writing Session Notes  cover image

Annotated Guidance for Writing Session Notes

Effective Date:1/1/0001 12:00:00 AM
This document provides guidance for writing the standardized session note form that is to be used by all Infant/Toddler Early Intervention programs. Updated March 2013.
Age:Infant/Toddler
Language:English
Authorization to Release Information for Children in Early Intervention cover image

Authorization to Release Information for Children in Early Intervention

Effective Date:5/28/2018 12:00:00 AM
This standard release form is used to obtain permission to share information with community agencies who are currently involved with local Early Intervention programs.
Age:Infant/Toddler,Preschool
Language:English
Authorization to Release Information for Infants/Toddlers with Hearing Concerns cover image

Authorization to Release Information for Infants/Toddlers with Hearing Concerns

Effective Date:1/1/0001 12:00:00 AM
A standard release form that will allow Early Intervention and the Department of Health to exchange information with a family of a child who is deaf or hard of hearing.
Age:Infant/Toddler
Language:English
Bureau of Special Education Complaint Information Packet and Form cover image

Bureau of Special Education Complaint Information Packet and Form

Effective Date:2/29/2016 11:00:00 PM
This form is used to submit a formal complaint to the PA Department of Education, Bureau of Special Education (BSE) - Division of Compliance. If you need more information about the complaint process or if you are unable to print the form and would like to receive a complaint form by mail, please contact the Special Education ConsultLine at 1-800-879-2301 (within the state of Pennsylvania) or 717-901-2146.
Age:School Age
Language:English
COMMUNICATION PLAN - School Age  cover image

COMMUNICATION PLAN - School Age

Effective Date:7/1/2008 11:00:00 PM
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 December 2010. At that time additions were made in Sections I and III of the plan to include communication needs and assistive technology devices and services for students who are deafblind. The revised plan has a footer reading December 2010. 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:10/8/2008 11:00:00 PM
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 December 2010. Changes have been made to the following areas: annotation added for Section I, question 5; to Section III concerning the definition of qualified interpreters, and to the glossary to include definitions of qualified interpreters and communication modes and assistive technology devices and services for students who are deafblind. The revised version has December 2010 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