Accommodations for statewide testing are available for students with IEP or 504 Plans or for students with a recent injury (such as a broken hand or arm). To request state test accommodation(s) for general assessments, please complete and submit this online form. General assessments in Hawai'i include Smarter Balanced, HSA Science (NGSS), KA'EO assessments, and End-Of-Course (EOC) exams (Biology and Algebra). This form should not be submitted for the HSA-Alt, WIDA, NAEP, or ACT tests.

Only one form is needed to request all the test accommodations for a student. For information about the documented evidence required for each test accommodation, please refer to the new Hawai'i State Test Accommodation Guides. We also recommend that school IEP/504 teams review Tables 1, 4, and 7 in the Crosswalk of Accessibility Features Across State Assessments in Hawai‘i 2020-2021 (CAF) for the range of accessibility supports that are available for each Smarter Balanced test prior to submitting this form. Please note that test accommodation(s) is/are requested based on the documented evidence in the student's IEP/504 Plans and the recommendations of your school IEP/504 Teams. 
 
IMPORTANT NOTE: Verified state test accommodations from SY 2019-20 will be carried over for use in SY 2020-21 (this currently applies only to SY 2020-21). Test Coordinators do not need to resubmit requests for this school year if the IEP/504 Team decides that the same verified accommodations are needed for a student in SY 2020-21. However, if there have been changes (adding/removing test accommodations) to a student’s IEP, the Test Coordinator or authorized school staff should complete this form and submit it to the Assessment Section. **Test accommodation requests should be submitted no later than 10 days prior to testing. 
 
If you require assistance to complete this form or have additional questions, please contact Elaine Lee (Elaine.Lee@k12.hi.us) in the Assessment Section.
 
For additional information about the accessibility supports that are available for statewide testing, please refer to the Accessibility and Accommodations resources page on the AlohaHSAP.org portal website. 

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* 1. Student 10-digit SSID: [Please check for accuracy to avoid delays in processing.]

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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 of school contact person submitting this form:

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* 7. Email address of school contact person submitting this form:

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

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* 9. Student is:

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* 10. Is the student taking the Kaiapuni Assessment of Education Outcomes (KĀ‘EO) assessment? [Please refer to the KĀʻEO Test Administration Manual for the complete list of assessment accommodations. Some of the accommodations listed below may not be available for the KĀʻEO.]

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* 11. Select the test accommodation(s) recommended by your School IEP/504 Team for the student:

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* 12. If applicable, select one option for the braille test accommodation recommended by your School IEP/504 Team for the student:

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* 13. Additional Comments:

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