Fillable Form to Report a Tesng Irregularity or Security (Illinois Assessment of Readiness)

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Form to Report a Tesng Irregularity or Security (Illinois Assessment of Readiness)

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The Form to Report a Tesng Irregularity or Security (Illinois Assessment of Readiness) form is 2 pages long and contains:

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2021 IAR Assessment
Form to Report a Tesng Irregularity or Security Breach
Instructions for the School Test Coordinator or District Test Coordinator:
1.
2.
3.
Complete this form, if instructed to do so by your District Test Coordinator or
ISBE. Submit this form within five school days.
Maintain a copy of the completed report for three years.
District Name:
School RCDTS Code:
School Name:
Contact Name: Role: DTC STC
Contact Phone and Extension:
Test Administraon Informaon:
Grade:
Subject:
Date of Incident:
Content Area: Math ELA/L
Mode: CBT PBT
Unit: 1 2 3
Test Administrator’s Name:
Student Name: Date of Birth:
Student ID Number:
Detailed Descripon of Incident:
Invesgaon Steps Taken:
Acons Taken by Sta to Resolve:
Was the incident resolved in a manner that allowed the student to connue tesng? Yes No
If incident was related to a parcular item, please provide item number (note that only students can read test content):
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Form to Report a Tesng Irregularity or Security (Illinois Assessment of Readiness)

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Completed 23 April 2021

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