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State Accommodations for statewide (interim and summative) testing are available for students with IEPs or Section 504 Plans or for students with a recent injury (such as a broken hand or arm). Please use one form to modify state test accommodations for an eligible student. The Department's general assessments do not include ACT, HSA-Alt, and WIDA Assessments. Note: KĀʻEO accommodation verification requests will be filed via a separate form here.
 
For information about the documented evidence of need for accommodation(s) on state tests, refer to Section 3 (Critical Considerations) the Hawai'i State Test Accommodation Guides and if applicable, the Guidance Brief: Math Manipulatives (MMs) State Test Temporary Accommodations. Also, we recommend reviewing Tables 1, 4, and 7 in the Crosswalk of Accessibility Features Across State Assessments in Hawai‘i 2022-2023 (Crosswalk/CAF) for information about all the accessibility supports that are available for state testing.
 
SY 2022-2023 State Test Accommodation Verification Request Options: 

Verified state test accommodations from SY 2021-22, except those provided due to hand and/or arm injuries, will be carried over to SY 2022-2023 if an accommodation verification request form was submitted to the Assessment Section by Friday, February 10, 2023. The school test coordinator (or authorized school contact) needs to submit this form to inform the Assessment Section regarding the IEP/504 Team's decision to keep/modify state test accommodation(s) as documented in a student's IEP/504 Plan. Refer to Section 3 (Critical Considerations) of the State Test Accommodation Guides and the Identification and Verification Process for Test Coordinators and School Assessment Teams (February 2023). 
 
Use this form to select the following request option(s) as provided under question #10:
  • NO CHANGE or retain IEP/504 student's prior verified state test accommodations. This option to carry over prior verified state test accommodation(s) for use in SY 2022-2023 is no longer available. No form is required if the student does not have any state test accommodations (refer to the "Statewide Assessment" tab in the IEP/504 Plan).
  • REMOVE prior verified state test accommodations; and/or
  • VERIFY/ADD new state test accommodations for SY 2022-2023.
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* 1. Student 10-digit SSID: [Please check for accuracy.]

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* 2. Enrolled Grade (select one):

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* 3. School Name:

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* 4. School 3-digit Code:

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* 5. Are you the Test Coordinator at your school?

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* 6. Name and email address of the school person submitting this form:

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* 7. Role of the school person submitting this form (check all that apply):

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* 8. Optional: Include up to two names and email addresses of school colleague(s) who should be kept informed about this request:

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* 9. Student is:

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* 10. Select the state test accommodation option(s) for the student (check all that apply):

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* 11. Select the state test accommodation(s) requested for verification:

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* 12. If applicable, select the braille code accommodation(s) for state tests (check all that apply):

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* 13. If you requested verification of Math Manipulatives (MMs) under question #11, then select from the list of pre-approved (MMs) below. Up to four MM accommodations are allowed for a student. If a MM accommodation is not listed, state the MM in the "Other MM" box. The Assessment Section will verify all (pre-approved and unlisted) MMs to ensure they are documented in the student's IEP/504 Plan and meet the administration requirements provided in the Guidance Brief: Math Manipulatives (MMs) State Test Temporary Accommodations.

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* 14. Additional Comments:

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