Fillable IAR Assessment Computer-Based Chain-of-Custody Form Spring 2021 (Illinois Assessment of Readiness)

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IAR Assessment Computer-Based Chain-of-Custody Form Spring 2021 (Illinois Assessment of Readiness)

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IAR Assessment
Computer-Based Chain-of-Custody Form
Spring 2021
ELA/Literacy
(Check one subject)
(Check one unit)
Mathematics
Unit 1 Unit 2 Unit 3
Instructions for the School Test Coordinator: Use this form to track the distribution and return of all secure test
materials to and from Test Administrators. Make as many copies of this form as needed. Keep this form in your
school files for three years after testing. Do not send this form to ISBE. Do not send this form to Pearson.
District Name: District Code:
School Name:
Materials Moved from Locked Central Storage Area to Classroom # ______________
Date:
Time:
Number of Student Authorization Tickets:
Number of Headphones: *
Number of Mathematics Reference Sheets:
Sheets of Scratch Paper:
School Test Coordinator’s Name (please print):
School Test Coordinator’s Signature:
Test Administrator’s Name (please print):
Test Administrator’s Signature:
Materials Moved from Classroom # ______________to Locked Central Storage Area
Date:
Time:
Number of Student Authorization Tickets:
Number of Mathematics Reference Sheets: Sheets of Scratch Paper: Number of Headphones: *
School Test Coordinator’s Name (please print):
School
Test Coordinator’s Signature:
Test Administrator’s Name (please print):
Test Administrator’s Signature:
Materials Securely Destroyed
Date:
Time:
Number of Student Authorization Tickets:
Number of Mathematics Reference Sheets:
Sheets of Scratch Paper:
School Test Coordinator’s Name (please print):
School Test Coordinator’s Signature:
Additional person present during shredding – Name (please print):
Additional person present during shredding – Signature:
*For inventory purposes if needed. Headphones are not considered secure testing materials.
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IAR Assessment Computer-Based Chain-of-Custody Form Spring 2021 (Illinois Assessment of Readiness)

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Completed 23 April 2021

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