Form 05-15-025 - Test Security Agreement - 2015-2016

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Test Security Agreement
2015-2016
Level 5 Test Administration Support: employees who come in contact with test
materials or assist with testing; these employees are not administering,
proctoring, or monitoring students during test administration.
School and district personnel responsible for test administration shall read and sign a Test
Security Agreement (TSA), on a form provided by the Alaska Department of Education & Early
Development, affirming that they will follow the test administration procedures required by the
department and the test publisher. This form must be signed annually and must be on file prior
to receiving any test materials and/or administering any tests. 4 AAC 06.765 (f)(1); 4 AAC
06.761(c)
Directions:
• Please fill out the identification section accurately.
• Read each statement carefully and initial each line to indicate that you agree to follow
these procedures in the context of your role(s).
• If a line does not apply to you, please indicate by writing N/A.
• Please sign your full name and date the form.
Identification
Name (Last, First MI):
District:
School/Site:
Testing Role (check all that apply)
Level 5: Support
Any district employee who
____ Testing Personnel (such as: administrative assistant, secretary, mail
comes into contact with
room, custodian, etc.)
testing materials; these
employees do not proctor,
____ Technology Assistance Personnel (such as computer lab or technology
administer, or monitor test
assistants)
administration to students.
Form #05-15-025
1 of 7
Alaska Department of Education & Early Development

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