2020 PSSA/Keystone UNIQUE
1. This accommodation is intended for those students with a severe disability that precludes
them from accessing and responding to instructional and assessment materials through
typical means, such as the hard copy test booklet or typical calculator.
2. The district and school are responsible for making the determination that the student is only
able to access the assessment through a unique accommodation.
3. The SAC must complete and submit this form to PDE at RAfirstname.lastname@example.org.
Requests will not be considered without supporting documentation attached to this form.
4. Attach a redacted copy of the following parts of the current IEP; PA Secure ID, Present
Educational Levels, Specially Designed Instruction (SDI), & Part IV (State Assessment
section) of the IEP, or the accommodations page of the current 504 Plan.
5. Requests must be made no later than 8 WEEKS prior to the start of the testing window to
allow for review and response to the school district.
6. Members of the Bureau of Curriculum, Assessment, and Instruction and the Bureau of Special
Education will review the requests and notify the district of the results.
7. PDE may request the supporting documentation as needed for monitoring or as part
of a testing irregularity investigation.
8. Mark the accommodation on the demographics accommodations section.
Student PA Secure ID:
Name/Title of Person Completing Request:
Revised 10/2019 Unique Accommodation Form 1