Oregon Department of Education Office of Assessment and Information Services
District Testing Responsibility Delegation Form
Under OAR 581-022-2100, school districts may delegate responsibility for test administration duties to another
school district or education service district for students attending a specific school or program. Districts
entering into an agreement to delegate test administration responsibility must complete this District Testing
Responsibility Delegation Form. The term of this District Testing Responsibility Delegation Form may not
exceed the current school year.
Delegating District Information
School District Name/ID:
Superintendent Name:
District Test Coordinator Name:
District Test Coordinator E-Mail Address:
District Test Coordinator Phone:
Receiving District Information
School District Name/ID:
Superintendent Name:
District Test Coordinator Name:
District Test Coordinator E-Mail Address:
District Test Coordinator Phone:
School / Program Information
School / Program Name/ID:
School Test Coordinator Name:
School Test Coordinator E-Mail Address:
School Test Coordinator Phone:
Delegated Testing Responsibilities
The Delegating School District delegates responsibility for the following test administration duties to the
Receiving School District for students attending the school or program identified above (check all that
apply):
Training of test administrators
Providing students with access to the Oregon Statewide Assessment System
Ordering and returning appropriate paper-based tests
Ensuring a secure testing environment for students
Investigating testing improprieties
The Receiving School District will notify the Delegating School District of any testing improprieties that
impact students for whom the Delegating School District has delegated testing responsibility. The
Page 1 of 2 Updated 6/30/10
