2021 IAR Assessment
Post-Test Cer fi ca on Form
This form is to be completed a er test administra on. Refer to your ISBE policy for who (School Test Coordinator or
District Test Coordinator) should complete the form and how the form is submi ed.
By subming this form, I cerfy that administra on of the IAR assessments has been completed at the following
school/district according to IAR security policies. All known security breaches and testing irregularies have
been properly reported.
First Name Last Name
State Role
School Name Phone Number and Ext
District Name
School Organiza on Code
Administra on District Organiza on Code
Were any Forms to Report a Tes ng Irregularity or Security Breach submi ed for the school? ❒ Yes ❒ No
All secure test materials have been returned to Pearson. Any secure test materials not returned to Pearson have been
tracked, destroyed and/or reported using the Form to Report Contaminated, Damaged, or Missing Materials.
Ship back date Number of scorable boxes shipped _____________
Number of nonscorable boxes shipped _____________
Were any Forms to Report Contaminated, Damaged or Missing Materials submi ed for the school? ❒ Yes ❒ No
Full Name (printed) Date
School Test Coordinator Signature
Principal (if diff erent from above)
Full Name (printed) Date
Principal Signature
Check ISBE policy for specific requirements for how long to maintain this document and whether or not you are
required to submit this form to your state.
click to sign
signature
click to edit
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click to sign
signature
click to edit
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