To request state test accommodations for a student, please complete and submit this form. No paper test accommodation request forms will be accepted. Test accommodations are based on the recommendations of your School IEP/Section 504 Plan Team.

IMPORTANT NOTE: Verified state test accommodations from SY 2019-20 will be carried over for use in 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 and submit this form to the Assessment Section. 

We recommend that you submit your students' test accommodation requests by Monday, November 2, 2020 for testing in the Fall 2020 Semester and by Friday, January 15, 2021, for testing in the Spring 2021 Semester. Please note that test accommodation requests should be submitted no later than 10 days prior to testing. 

If you require assistance to complete this form, please contact the Assessment Section: Elaine Lee (Elaine.Lee@k12.hi.us) or Sue Forbes (Susan.Forbes@k12.hi.us).

For more information about the new test accommodation request process or the new test accommodation guides, please consult the Accessibility and Accommodations resources page on the AlohaHSAP.org portal website. 

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* 1. Student 10-digit SSID: [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. Select the test accommodation(s) recommended by your School IEP/504 Team for the student:

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

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* 12. Additional Comments:

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