Fillable Use of an Emergency Accommodation on a IAR (Illinois Assessment of Readiness)

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Use of an Emergency Accommodation on a IAR (Illinois Assessment of Readiness)

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Use of an Emergency Accommodation on a IAR Assessment
Direcons: This form is appropriate in cases where a student needs a new accommodaon immediately
prior to the assessment due to unforeseen circumstances. Cases could include students who have a
recently-fractured limb (e.g., ngers, hand, arm, wrist, or shoulder); whose only pair of eyeglasses has
broken; or a student returning from a serious or prolonged illness or injury. If the principal (or
designee) determines that a student requires an emergency accommodation on the day of the IAR
test, this form must be completed and maintained in the student’s assessment file. The parent must
be notified that an emergency accommodation was provided. Refer to Section 6.3 of the Test
Coordinator Manual for Illinois requirements for approving emergency accommodations. Consult
with your local district office for approval if required by ISBE. If appropriate, this form may also be
submitted to the district assessment coordinator to be retained in the student’s central office file.
District Name: Date:
School Name: Telephone Number:
Student Name: Grade:
Student ID #: DOB:
Name and Title of Person Compleng this Form:
_________________________________ __________________________________________
Sta Member’s Name Title/Posion
Reason for needing an emergency test accommodation (attach documentation if needed):
__________________________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________
Describe what the tesng accommodaon will be:
__________________________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________
Who will administer the accommodaon? ________________________________________________
______________________________________ ____________________________________
Sta Member’s Name Title/Posion
______________________________________ ____________________________________
Principal Signature Date
______________________________________ ____________________________________
Local Accountability Coordinator Signature Date
(if appropriate or required)
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Reason for needing an emergency test accommodation (continued):
Describe what the testing accommodation will be (continued):
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Use of an Emergency Accommodation on a IAR (Illinois Assessment of Readiness)

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Completed 23 April 2021

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