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* 1. Select school number and name.

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* 2. Are you the school's designated Test Chairperson?

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* 3. Enter the name of the person completing this form.

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* 4. Date this verification form was completed

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* 5. I certify that I viewed the screencast training for the Fall 2016 FSA and/or NGSSS EOC Assessments, and I agree to follow the test administration and security procedures presented.

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