Review of Accommodations Used During Testing
This form is to be completed in its entirety. Prior to testing, the accommodations that are documented on the student's IEP, 504 Plan, or LEP documentation are to be checked off. After testing, the test
administrator must complete the remaining columns regarding what actually took place during testing. Completed forms should be kept in the student's IEP folder or Section 504 or LEP documentation so
that it is accessible for future meetings and in case of auditing/monitoring of accommodations use. NOTE: While the list below includes all accommodations, some do not apply to students identified as LEP.
Student Name
Grade
Test
Choose one or more
EC (IEP)
LEP
504 Plan
Subject
of the following:
Date
Test Administrator
To Be Completed Prior to Testing
To Be Completed After Testing
If yes, provide specifics regarding
Was this
how this accommodation was
Accommodations Documented on Student's IEP/ Section 504
accommodation
provided. (This has been shaded for
Describe if and how the student used this accommodation
Plan/ LEP Documentation
provided to student
some accommodations if it does not
during testing?
apply.)
All items and answer choices were
Student completed test without following along with the
Example: Test Administrator Reads Test Aloud
Yes
read to student.
read aloud.
Braille Edition
Large Print Edition
One Test Item Per Page Edition
Assistive Technologies/Devices (Specify)
Braille Writer/Slate and Stylus (and Braille Paper)
Cranmer Abacus
Dictation to a Scribe
Interpreter/Transliterator Signs/Cues Test
Keyboarding Devices
Magnification Devices
Student Marks Answers in Test Book
Student Reads Test Aloud to Self
Test Administrator Reads Test Aloud (Specify)
Hospital/Home Testing
Multiple Testing Sessions
(Explain: ___________________)
Scheduled Extended Time
(Estimated Amount:_________)
Testing in a Separate Room
Other (Specify:_________________________________)
Comments/Considerations for next IEP/504/LEP team meeting:
Printed name of person completing form: ______________________________________
This form is available in electronic format at
Signature of person completing form: _________________________________________
NCDPI Division of Accountability Services
October 2009