Dallas Independent School District
Test CoordinatorSample Statement Regarding Irregularity(for STATE tests)6743705080Statements must be collected from all parties involved including the test coordinator.00Statements must be collected from all parties involved including the test coordinator.On April 9, 2019 two students were given the 5th grade STAAR Math test without the test accommodations (oral administration, small group) as stated in their IEP. This incident occurred in Room 105. (1, 3, 4, 6)I, (Complete Name), the campus test coordinator at (School), became aware of this on (Date). The (Position), (Complete Name), told me that when she asked the two students about their testing environment on the testing day, they told her they tested in a regular classroom with lots of students and the test administrator, (Complete Name), didn’t read the test to them. (2, 3, 7)I notified my Principal, (Complete Name), and called (Complete Name) in the (Department) on (Date) to get instructions on what to do next. The District Test Coordinator contacted TEA and I was directed to contact the parents for their permission to score or not score the tests. The parents were notified and they gave permission to have the tests scored. Both answer documents were submitted for scoring with the score code marked “S”. (8, 9, 10, 11, 12, 13)The test administrator, (Complete Name), (Position), had been trained on general test administration procedures and had signed an oath. Due to an error on my part, I did not pull the two students from the original class for them to receive their accommodations. (2, 14)In the future, I will have my assistant test coordinator double – check the accommodations list of students each morning of testing to ensure the students receive their accommodations. (15)Students: (6)John Doe 123-45-6789 (Social Security Number)Jane Doe S12345678 (PEIMS Number)________________________________________SignatureSusan Smith*The numbers in parenthesis represent theAP/Test Coordinator numbers of the questions that are beingXYZ Elementary School answered in that paragraph. They do not1234 Main Street need to be included in the actual statement.Dallas, Texas 75228Phone Number Email8/16/19 ................
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