Download Forms

Below are links to a number of Pennsylvania SBAP forms available for download, in both Adobe Acrobat and Microsoft Office formats. You may also continue to order forms directly from Leader by calling your Account Manager or using our Contact page.

Please Note: If your browser is configured to open MS Word or Acrobat PDF documents directly in the browser, you'll need to right-click (Macintosh: Ctrl-click) the link for the form you want above and choose "Save Link As..." (Firefox/Netscape users), "Save Linked file As..." (Safari users), or "Save Target As..." (Microsoft Internet Explorer Users) to save the file to your hard drive.

Logs	Select file format:
Direct and Collateral Services Log	Word	PDF
Nursing Services Log	Word	PDF
Occupational Therapy Services Log	Word	PDF
Orientation and Mobility Services Log	Word	PDF
Personal Care Assistant
Personal Care Assistant Weekly Log	Word	PDF
Instructions	Word	PDF
Personal Care Assistant Daily Encounter Log	Word	PDF
Instructions	Word	PDF
Physical Therapy Services Log	Word	PDF
Professional Services Log for Psychological Assessment	Word	PDF
Psychological Services Log	Word	PDF
Social Worker Log	Word	PDF
Speech, Language, and Hearing Services Log	Word	PDF
Teacher of the Hearing Impaired Services Log	Word	PDF

Other Forms
ACCESS Funds Request Form (PDE-352)	Excel	PDF
Instructions (PDE website) PA SBAP: PDE memo re: PDE-352 and PDE-352M requests for School Based Access Program Restricted Account Monies (PDF file, 8kb)
ACCESS Funds Request Form for EI Program (PDE-352M)	Excel	PDF
Administrative Time Study Cost Data Collection Template	Excel	N/A
Child Participation Form	Word	PDF
Direct Services Cost Worksheet	Word	PDF
Instructions	Word	PDF
Partially Federally Funded Staff	Word	PDF
Instructions	Word	PDF
Medicaid Transportation Claims Cost Report for IUs	Word	PDF
Medicaid Transportation Claims Cost Report for Schools and Charter	Word	PDF
Instructions	Word	PDF
Cost Worksheet - Attachment A	Word	PDF
Special Transportation Student List	Word	PDF
Student Transportation Log	Word	PDF
Instructions	Word	PDF
Medical Practitioner Authorization	Word	PDF
National Provider Identification (NPI)
Application	N/A	PDF
NPI Request Authorization	N/A	PDF
Parental consent:
SBAP Medical Assistance (MA) Billing Parental Consent Form - English (posted 05/31/2007)	Word	PDF
SBAP Medical Assistance (MA) Billing Parental Consent Form - Spanish (updated 11/19/2007)	Word	PDF
Understanding Parental Consent and the School-Based ACCESS Program - English (updated 03/04/2008)	N/A	PDF
Parental Consent - Frequently Asked Questions	Word	PDF
May 3, 2007 OSEP Clarification Letter about Parental Consent Regulation 300.154 (PDF, 668kb)
Service Provider Update Form	Word	PDF
Self Audit Form	Word	PDF
Self Audit Instructions	Word	PDF
Service Description Slip	Word	PDF
SBAP Service Provider Evaluation Log	Word	PDF

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