For all staff involved with administrations of MSAA Alternate Assessment. I acknowledge that the MSAA Alternate Assessment is a secure assessment and as Test Coordinator agree to ensure the following conditions of use to ensure test security or as Test Administrator agree to the following conditions of use to ensure test security:

1. Take necessary precautions to safeguard all test materials.
2. Receive training necessary to administer MSAA Alternate Assessment.
3. Read the MSAA Alternate Assessment Test Administration Manual.
4. Enter all required student information in the MSAA assessment system: Student Demographics Information, Learner Characteristics Inventory (LCI), Student Administration Record (SAR), and complete the required Response Check with each tested student.
5. Download and read all instructions in the Directions for Test Administration for the MSAA Alternate Assessment forms/s being administered.
6. Prepare adequate test materials for each student to be tested as specified in the Direction for Test Administration.
7. Ensure authorized accommodations are prepared, available, and provided.
8. Establish an appropriate setting for test administration (location, equipment, schedule, etc.).
9. Follow exactly the Directions for the Test Administration provide with each test form, when administering the Pilot 1 Test.
10. Report inappropriate test practices to the Test Coordinator or as the Test Coordinator will report irregularities to SD DOE using the Test Irregularity Form.
11. Complete the End of Test Surveys.
12. Destroy all printed copies of the test, Directions for Test administration, scoring rubrics, student log in information, scratch paper, etc.

By submitting my name on this form, I am assuring that I will abide by the above conditions.

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* 1. District/Agency

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* 2. Name

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* 3. Role in test administration
(check all that apply)

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* 4. Name of district test coordinator

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