Special Education Forms
General Forms
- Agreement To Waive Reevaluation (Word Document)
- Alternative Education for Disruptive Youth (AEDY) Referral Form (Word Document)
- Classroom Visitation (Word Document)
- Evaluation Report (Word Document)
- Functional Assessment Interview Forms (Word Document)
- Functional Assessment Observation Tools (Word Document)
- Functional Assessment Secondary Team Forms (Word Document)
- Functional Behavioral Assessment Worksheet (Word Document
- Individualized Education Program (IEP) (Word Document)
- Invitation to Participate in the IEP Team Meeting or Other Meeting (Word Document)
- Manifestation Determination Worksheet (Word Document)
- Notice of Recommended Educational Placement/Prior Written Notice (NOREP/PWN) (PDF Document)
- Parental Consent to Excuse Members from Attending the IEP Team Meeting (Word Document)
- Permission to Evaluate—Evaluation Request Form (Word Document)
- Permission to Reevaluate—Consent Form (Word Document)
- Permission to Reevaluate—Reevaluation Request Form (Word Document)
- Prior Written Notice for Initial Evaluation and Request for Consent Form (Word Document)
- Prior Written Notice for Initial Reevaluation and Request for Consent Form (Word Document)
- Procedural Safeguards Letter (Word Document)
- Procedural Safeguards Notice (Word Document)
- Reevaluation Report (RR) (Word Document)
- Referral for Support Services (Word Document) Referral for Support Services (PDF Version)
- Summary of Academic Achievement and Functional Performance (Word Document)
School Age Transition Surveys
- Student Academic Transition Survey (Word Document)
- Parent/Guardian Academic Transition Survey (Word Document)
- Student Functional Transition Survey/Interview (Word Document)
- Parent/Guardian Functional Transition Survey (Word Document)
Authorization to Release/Request Information
- Intermediate Unit 1 Authorization to Release Information
- Intermediate Unit 1 Authorization to Release Information (PDF)
Annotated Forms
- Agreement to Waive Reevaluation (PDF Document)
- Evaluation Report (PDF Document)
- Individualized Education Program (IEP)
- Invitation to Participate in the IEP Team Meeting or Other Meeting (PDF Document)
- Kindergarten Transition Teacher Input for Case Managers/Contributors (PDF Document)
- Notice of Recommended Educational Placement/Prior Written Notice (NOREP/PWN) (Word Document)
- Notice of Recommended Educational Placement/Prior Written Notice for Revocation of Consent for Special Education Services
- Parental Consent to Excuse Members from Attending the IEP Team Meeting (PDF Document)
- Permission to Evaluate—Evaluation Request Form (PDF Document)
- Permission to Reevaluate—Consent Form (PDF Document)
- Permission to Reevaluate—Reevaluation Request Form (PDF Document)
- Positive Behavior Support Plan (PDF Document)
- Prior Written Notice for Initial Evaluation
- Prior Written Notice for Reevaluation
- Reevaluation Report (PDF Document)
- Summary of Academic Achievement and Functional Performance (PDF Document)
Social Worker Forms
- Allegheny General Hospital Authorization for Release of Protected Health Information (PDF Document)
- Axiom Family Counseling Services, Inc. Consent for Release of Protected Health Information (PDF Document)
- Children's Hospital of Pittsburgh Authorization for Release of Protected Health Information (PDF Document)
- Cornerstone Care Counseling Department Release of Information (PDF Document)
- Chestnut Ridge Counseling Services, Inc. Authorization for Use/Disclosure of Health Information (PDF Document)
- Laurel Pediatrics, PC Authorization for the Release of Medical Record Information (PDF Document)
- Monsour Medical Center Authorization to Release/Obtain Information (PDF Document)
- Southwood Psychiatric Hospital Authorization to Release Information (PDF Document)
- University of Pittsburgh Medical Center Authorization for Release of Protected Health Information (PDF Document)
- West Virginia University Health Service Authorization for Release of Information (PDF Document)
- WJS Psychological Associates, Inc. Consent for Release of Information (PDF Document)
Fayette County Social Worker Forms
- Child and Family Urgent Response and Stabilization Team’s Web Referral Form (PDF Document)
- Fayette Area Coordinated Transportation Consumer Welcome Brochure (PDF Document)
- Fayette Area Coordinated Transportation Escort Eligibility Physician Verification Form (PDF Document)
- The Medical Assistance Transportation Program Basic Informational Brochure (PDF Document)
