30-Day Notice For Statewide Tests - Oregon Department Of Education

30-Day Notice For Statewide Tests - Oregon Department Of Education - 2016/2017 Page 2

2016-17 Opt-Out Form

DESCRIPTION OF RIGHTS

House Bill 2655 permits parents and adult students* to annually opt-out of Oregon’s statewide summative

tests in English Language Arts and Math by submitting this form to the school the student attends. The

school shall provide any student who is exempted from a state test with supervised study time while other

students are testing. Visit this link to learn more about House Bill 2655:

To opt-out of state tests, this section must be completed by the parent/guardian or adult

student:

Student’s Legal Last Name___________________________________________________________________

Student’s Legal First Name___________________________________________________________________

Student’s Enrolled Grade______________________

Student’s School_________________________________________

Please indicate the state test(s) you are opting out of for the 2016-17 school year:

English Language Arts

Mathematics

To best support school district planning, you are encouraged to submit this form to your child’s school by

February 1, 2017. For students who enroll after the statewide testing window begins on February 7, 2017, you

are encouraged to submit the form within 2 weeks of enrollment. This form is only valid for the 2016-17

school year. Parents and adult students are required to submit an opt-out form annually should they wish to

be exempted from statewide summative tests.

I understand that by signing this form I am opting my child out of testing.

Parent/Guardian* ___________________________________________Date_______________

(signature)

Parent/Guardian* ______________________________________________________________

(printed name)

*Adult students (age 18 and older) may sign on their own behalf and do not require a signature by a parent or guardian.

30-Day Notice For Statewide Tests - Oregon Department Of Education - 2016/2017 Page 2