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Request Form for IEP/IFSP Facilitation & Mediation.

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Fill out the following form online.
The form must be completed in its entirety with a value for all required fields. Partial forms cannot be saved and accessed at a later date.

 

Mediation Request Form (IEP/IFSP) (English) - Accessible

  • ex: 000-000-0000 or 000-000-0000x000
  • Student Information

  • Date format: MM/DD/YYYY
  • Parent/Guardian Information

  • ex: 000-000-0000 or 000-000-0000x000
  • ex: 000-000-0000 or 000-000-0000x000
  • ex: 000-000-0000 or 000-000-0000x000
  • Second Parent or Parent not residing with the Student:

  • ex: 000-000-0000 or 000-000-0000x000
  • ex: 000-000-0000 or 000-000-0000x000
  • ex: 000-000-0000 or 000-000-0000x000
  • Local Education Agency (LEA) Information

  • ex: 000-000-0000 or 000-000-0000x000
  • ex: 000-000-0000
  • Please complete this section if you are requesting any type of facilitation service.

  • date, time and location

 

  • Parents with questions about these services or other dispute resolution options may contact the Special Education ConsultLine at 800-879-2301 or 717-901-2146.
  • Any birth-3 questions should be referred to OCDEL at 717-346-9320.
  • On occasion, an ODR staff person may ask to attend any of these meetings for purposes of evaluating the service. Parties will be notified ahead of time, and any questions will be addressed at that time.