MISSISSIPPI DEPARTMENT OF EDUCATION TESTING IRREGULARITY FORM
Central High School Building • 359 North West Street • P. O. Box 771 • Jackson, MS 39205-0771
Instructions for District Test Coordinators and School Test Coordinators:
1. The School Test Coordinator (“STC”) shall immediately notify the District Test
Coordinator (“DTC”) by email, telephone or facsimile of all testing irregularities and
test security incidents. See Appendix F.
2. After notifying the DTC, the STC shall complete this form in its entirety and submit
the form to the DTC along with copies of the following documents: School Test
Security Plan, Current Training Agenda and Sign In Sheets and Seating Chart for
testing room(s) involved.
3. The DTC must immediately notify Test Security of the testing irregularity by
emailing to testsecurity@mdek12.org. If there is a question whether the incident
requires a student’s test to be invalidated, please follow the new procedure and call
Walt Drane directly at 769-300-1238.
4. The DTC shall upload this form and all attached documents into SharePoint within 24
hours of notifying the Office of Student Assessment of the irregularity. Email Test
Security at testsecurity@mdek12.org to notify that the form has been uploaded.
District Name and Number:
School Name:
School Test Coordinator Name:
School Test Coordinator Cell Phone Number:
District Test Coordinator Name:
District Test Coordinator Cell Phone Number:
Assessment:
Grade: Subject:
Date and Time of Incident:
Test Administrator Name and Cell Phone Number:
Proctor Name and Cell Phone Number:
Student Name and State ID Number:
