ACCEL Handbook - Volusia County Schools - Homemyvolusiaschools.org/student-support-services/Documents/ACCEL... · 2 Volusia County School Board Members Mrs. Ida D. Wright, Chairman

2016-2017

Academically Challenging Curriculum to

Enhance Learning (ACCEL) Options

2

Volusia County School Board Members

Mrs. Ida D. Wright, Chairman

Mrs. Melody Johnson, Vice-Chairman

Mrs. Linda Costello

Mrs. Linda Cuthbert

Dr. John Hill

Mr. James T. Russell

Superintendent of Schools

Ms. Teresa Marcks

Chief Academic Officer

3

ELEMENTARY ACCEL OPTIONS

The Volusia County School District provides academically challenging curricula and accelerated

instruction to eligible elementary school students. Eligibility requirements and procedures have been

established by the district. According to s.1002.3105, F.S., ACCEL options include, but are not limited

to, whole grade and mid-year promotion, subject matter acceleration, virtual instruction and the Credit

Acceleration Program (CAP). Refer to the Student Progression Plan for detailed information

concerning ACCEL.

If a student is being considered for whole grade acceleration, the principal should follow the process

outlined for district promotion/retention requests. Contact the Student Services Department at ext.

20759 for additional information.

ACCEL Eligibility

Any student currently enrolled in a Volusia County School may apply for acceleration opportunities.

To initiate the acceleration process, the student’s parent must submit a written request to the

principal/designee of the student’s school of enrollment.

Eligibility for one or more acceleration opportunities is determined by, but not limited to, the following: (1) data indicating that the student has the ability to perform above grade level; (2) student attendance and conduct record; (3) recommendation from one or more of the student’s teachers in core-curricula courses as

defined in s.1003.01(14)(a)-(e), F.S.; (4) score of Level 3 or above on statewide, standardized assessments;

(5) evidence that the academic requirement(s) for selected program(s) have been met.

For gifted students with active EP, recommendation for whole grade acceleration for gifted

learners is determined by the need of the student for acceleration as indicated by the team

members of the Education Plan (EP) committee which is comprised of, but not limited to,

parents, school counselor, the principal or designee, teachers from each of the affected grade

levels, placement specialist, and the gifted program specialist.

OVERVIEW OF OPTIONS

Credit Acceleration Program (CAP)

The CAP is created for the purpose of allowing students to earn high school credit in courses that

require statewide, standardized end-of-course (EOC) assessments and/or advanced placement

courses. Credit will be awarded by the district for any student who attains a Level 3 or above as

defined in s.1008.22(3) (c) 5, F.S. Students are not required to be enrolled in the course or to have

completed the course. A student who is not enrolled in the course or who has not completed the

course will take the statewide, standardized EOC assessment or Advanced Placement Exam during

the regular administration of the assessment.

Students requesting to participate in the end-of-course exam must submit a completed Credit by

Exam Request Form with the testing coordinator and counselor at the current school of enrollment

nine weeks prior to the state-mandated testing window. Students requesting to participate in an

http://www.flsenate.gov/Laws/Statutes/2012/1003.01

http://flsenate.gov/Laws/Statutes/2011/1008.22

4

Advanced Placement Exam for a course in which they are not enrolled in will be required to pay the

associated exam fee and will need to register with the school-based Advanced Placement Testing

Coordinator, as outlined in the Student Progression Plan.

Online Courses

When a school has identified a student as eligible for acceleration, choosing a virtual option is based

on the following, s.1002.455, F.S.:

(a) The student spent the prior school year in attendance at a public school in this state

and was enrolled and reported by the school district for funding during the preceding

October and February for purposes of the Florida Education Finance Program (FEFP)

surveys.

(b) The student is a dependent child of a member of the United States Armed Forces who

was transferred within the last 12 months to Florida from another state or from a

foreign country pursuant to a permanent change of station order.

(c) The student was enrolled during the prior school year in a school district virtual

instruction program, a K-8 Virtual School Program or a full-time Florida Virtual School

program.

(d) The student has a sibling who is currently enrolled in a school district virtual instruction

program and the sibling was enrolled in that program at the end of the prior school

year.

(e) The student is eligible to enter kindergarten or first grade.

Volusia Online Learning (VOL)

Students who qualify for an ACCEL option and meet statutory eligibility may opt to take one or more

courses virtually through Volusia Online Learning. Online courses meet the needs of students who

learn more productively in their own time and in their own space. Enrollment in a virtual course, for

the purpose of acceleration only, must be completed by the zoned school counselor and added to the

student’s schedule either during or beyond the school day. Students are not required to take courses

beyond the school day, but may, if beneficial to the student’s needs. Counselors should contact the

Online Learning offices for enrollment assistance by calling 386-506-0014 or by contacting Wendy

Ferranti at extension 38376 or by email at [email protected].

Florida Virtual School

FLVS is authorized to provide instruction for eligible students in kindergarten through grade 5 for the purpose of acceleration. Elementary students who qualify for the ACCEL option may choose FLVS for middle school courses only. The zoned school ACCEL team must make the determination of student eligibility. Approval of an FLVS course is up to the discretion of the school and the school will add each course to the student’s schedule either during or beyond the school day. Students are not required to take courses beyond the school day, but may, if beneficial to the student’s needs. More information regarding course offerings is available at flvs.net.

mailto:[email protected]

5

ACCEL Procedures

Subject Area Acceleration

Upon receipt of the written parent request for acceleration, the procedural requirements for

subject area acceleration are as follows:

(1) A school-based data review is conducted. (2) School principal/designee determines student eligibility in accordance with the subject area

acceleration guidelines outlined in this handbook. (3) School designee, in conjunction with the parent and student, develops the Elementary

Acceleration Plan Performance Contract (page 6) that includes an acceleration plan and timeline, minimum student attendance requirements, minimum student conduct requirements, and possible participation in extracurricular activities, field trips, interscholastic competitions, and other activities related to the ACCEL option selected.

(4) Principal approves and signs the Elementary Acceleration Plan Performance Contract. (5) School principal/designee contacts the parent regarding approval of the plan. (6) If the student successfully completes the plan, he/she will be placed in the next sequential

course or grade level.

Whole Grade Acceleration for Gifted Learners

Recommendation for whole grade acceleration for gifted learners is determined by the team

members of the Education Plan (EP) committee which is comprised of, but not limited to, parents,

school counselor, principal/designee, teachers from affected grade levels, placement specialist,

and the gifted program specialist. Requests for whole grade acceleration EP Committee

Meetings must be submitted prior to April 15th of each school year.

Students who do not successfully meet the outlined eligibility requirements may apply for an

appeal. Parents of these students should contact the school principal or designee to request

appeal paperwork. Once completed, the parent should send the paperwork to Deb Drawdy,

Coordinator Student Services. Refer to Student Packet Checklist (page 7) for the required

documentation.

6

Elementary Acceleration Plan Performance Contract

Student Name__________________________________ Date____________________________

Alpha Code____________________________________ Date of Birth _____________________

Current Grade _________________________________ Age ____________________________

School Name ____________________________________________________________________

Is student currently identified as gifted? ____ If not, is gifted eligibility suspected? _____

If gifted suspected, date of referral:____________(referral not required for subject-area

acceleration; only for whole grade acceleration)

Specific Reason for Request: (Please print)

Documentation to Support Request: Attach supporting documentation, i.e., copy of statewide, standardized assessment

scores, online course grades, teacher recommendation, parent conference notes, etc.

Acceleration Plan and Timeline: Develop an Individual Acceleration Plan that addresses the specific needs, goals, and

objectives for identified student. Include timeline and progress monitoring dates.

Special Circumstances That Should Be Noted: (optional)

Conference Dates: _______________________________________________________________ Student will adhere to school and district policies regarding attendance, behavior, and extracurricular activities.

________________________________________________ ______________________________________________ Student Signature Date Parent Signature Date

________________________________________________ ______________________________________________ Counselor Signature Date Principal/Designee Signature Date

8/1/16

7

CREDIT BY EXAM REQUEST FORM Volusia County Schools


Student Name: _______________________________________ ALPHA: ______________

Current School of Enrollment: ___________________________ Grade: _______________

Exam to be taken for course credit (check all that apply):

Algebra I End-of-Course Exam Geometry End-of-Course Exam

Biology End-of-Course Exam U.S. History End-of-Course Exam

Algebra II End-of-Course Exam Advanced Placement (AP) Exam

If you selected Advanced Placement (AP) Exam, please indicate which exam(s) you are requesting to take:

___________________________ ____________________________

___________________________ ____________________________

My signature below indicates that I understand my student will be participating in the exam(s) selected above.

High school credit will be awarded for the course if my student scores a Level 3 or above.

____________________________ _______________________________

Parent/Guardian Signature Print Name

_______________________________

Date

My signature below indicates that I understand that I will be participating in the exam(s) selected above. If I

score a Level 3 or above I will earn high school credit for the course(s) associated with the exam(s).

____________________________ _______________________________

Student Signature Print Name

_______________________________

Date

This form must be completed nine weeks prior to the start of the testing window. Upon completion of this form,

the school counselor will give a copy of this completed form to the school-based testing coordinator.

____________________________ _______________________________

Counselor Signature Print Name

_______________________________

Date

Original document: student’s cumulative folder

Copies: parent/guardian school based testing coordinator district testing coordinator

8/1/16

8

MIDDLE SCHOOL ACCEL OPTIONS

The Volusia County School District provides academically challenging curricula and accelerated instruction to eligible middle school students. Eligibility requirements and procedures have been established by the district. According to s.1002.3105, F.S., ACCEL options include, but are not limited to, whole grade and mid-year promotion, subject matter acceleration, virtual instruction, and the Credit Acceleration Program (CAP). Refer to the Student Progression Plan for detailed information concerning ACCEL. If a student is being considered for whole grade acceleration, the principal should follow the process

outlined for district promotion/retention requests. Contact the Student Services Department at ext.

20759 for additional information.

ACCEL Eligibility Any student currently enrolled in a Volusia County School may apply for acceleration opportunities.

To initiate the acceleration process, the student’s parent must submit a written request to the

principal/designee of the student’s school of enrollment.

Overview of Options

Awarding Credit for High School Courses Completed in Middle School

Students receive credit for high school courses successfully completed in middle school. The full high

school curriculum is taught in these courses, and all required district and state assessments are given

to the students at the time the course is taken. The earned grade in these courses will become part of

the high school transcript and Grade Point Average (GPA) calculation.



require statewide, standardized end-of-course (EOC) assessments. Credit will be awarded by the

district for any student who attains a level 3 or above, as defined in s.1008.22(3)(c)5, F.S. Students

are not required to be enrolled in the course or to have completed the course. A student who is not

enrolled in the course or who has not completed the course will take the statewide, standardized

EOC assessment during the regular administration of the assessment. Any student who has not

been enrolled in a course or taken the EOC will be enrolled in the appropriate grade-level course

according to the district program of studies.

Students requesting to participate in the CAP must have filed a completed Credit by Exam Request

Form with the testing coordinator and counselor at the current school of enrollment nine weeks prior

to the state-mandated testing window.

Online Courses






surveys.


9





instruction program, a K-8 Virtual School Program, or a full-time Florida Virtual School

program.



year.


Students who qualify for an ACCEL option and meet statutory eligibility may opt to take one or more

courses virtually through Volusia Online Learning. Online courses meet the needs of students who

learn more productively in their own time and in their own space. Enrollment in a virtual course for the

purpose of acceleration only, must be completed by the zoned school counselor and added to the

student’s schedule either during or beyond the school day. Students are not required to take courses

beyond the school day, but may, if beneficial to the student’s needs. Counselors should contact the

Online Learning offices for enrollment assistance by calling 386-506-0014 or by contacting Wendy

Ferranti at extension 38376 or by email at [email protected].


FLVS is authorized to provide instruction for eligible students for the purpose of acceleration. The zoned school ACCEL team must make the determination of student eligibility. Approval of an FLVS course is up to the discretion of the school and the school will add each course to the student’s schedule either during or beyond the school day. Students are not required to take courses beyond the school day, but may, if beneficial to the student’s needs. More information regarding course offerings is available at flvs.net.

Whole Grade Acceleration for Gifted Learners

Recommendation for whole grade acceleration for gifted learners is determined by the team members of the Education Plan (EP) committee which is comprised of, but not limited to, parents, school counselor, principal/designee, teachers from affected grade levels, placement specialist, and the gifted program specialist. Requests for whole grade acceleration EP committee meetings must be submitted prior to April 15th of each school year.

ACCEL Procedures

Upon receipt of the written parent request for acceleration, the procedural requirements for whole grade, mid-year, and/or subject matter acceleration are as follows: (1) A school-based data review is conducted. (2) School principal/designee determines student eligibility in accordance with the subject area

guidelines provided by the district, outlined in this handbook. (3) School designee, in conjunction with the parent and student, develops the Middle School

Acceleration Plan Performance Contract (page 11) that includes an acceleration plan and timeline; minimum student attendance requirements; minimum student conduct requirements; and possible participation in extracurricular activities, field trips, interscholastic competitions, and other activities related to the ACCEL option selected.

(4) Principal approves and signs the Middle School Acceleration Plan Performance Contract. (5) School principal/designee contacts the parent regarding approval of the plan.


10

(6) If the student successfully completes the plan, he/she will be placed in the next sequential course or grade level.

Students who do not successfully meet the outlined eligibility requirements may apply for an appeal.

Parents of these students should contact the school principal or designee to request appeal

paperwork. Once completed, the parent should send the paperwork to Deb Drawdy, Coordinator of

Student Services.

11

Middle School Acceleration Plan Performance Contract

Student Name__________________________________ Date____________________________

Alpha Code_____________________________________ Date of Birth____________________

Current G.P.A. __________________________________ Age____________________________

Current Grade Level_____________________________ School Name_____________________

Is student currently identified as gifted? ____ If not, is gifted eligibility suspected? ____

If gifted suspected, date of referral:_______(referral not required for subject-area acceleration;

only for whole grade acceleration)

Specific Reason for Request: (Please print)

Documentation to Support Request: Attach supporting documentation, i.e., copy of statewide, standardized assessment

scores, online course grades, teacher recommendations, parent conference notes, etc.

Acceleration Plan and Timeline: Develop an Individual Acceleration Plan that addresses the specific needs, goals, and objectives

for identified student. Include timeline and progress monitoring dates.

Middle School Courses Completed: Attach documentation regarding middle school coursework that has already been

completed or currently in progress.

Conference Dates: ___________________________________________________________________ Student will adhere to school and district policies regarding attendance, behavior, and extracurricular activities.

_______________________________________________ ________________________________________________ Student Signature Date Parent Signature Date

_______________________________________________ ________________________________________________ Counselor Signature Date Principal/Designee Signature Date

8/1/16

12

CREDIT BY EXAM REQUEST FORM

Volusia County Schools









___________________________ ____________________________

___________________________ ____________________________

My signature below indicates that I understand my student will be participating in the exam(s) selected above.

High school credit will be awarded for the course if my student scores a Level 3 or above.

____________________________ _______________________________


_______________________________

Date

My signature below indicates that I understand that I will be participating in the exam(s) selected above. If I

score a Level 3 or above I will earn high school credit for the course(s) associated with the exam(s).

____________________________ _______________________________


_______________________________

Date

This form must be completed nine weeks prior to the start of the testing window. Upon completion of this form,

the school counselor will give a copy of this completed form to the school-based testing coordinator.

____________________________ _______________________________


_______________________________

Date


Copies: parent/guardian school based testing coordinator district testing coordinator

8/1/16

13

HIGH SCHOOL ACCEL OPTIONS

The Volusia County School District provides academically challenging curricula and accelerated

instruction to eligible high school students. Eligibility requirements and procedures have been

established by the district. According to s.1002.3105, F.S., ACCEL options include, but are not limited

to, the Credit Acceleration Program (CAP), subject matter acceleration through Advanced

Placement (AP), International Baccalaureate (IB), dual enrollment and early admission courses,

career academy courses, courses that lead to national industry certification, virtual instruction, and

accelerated graduation options.

The Department of Education Office of Articulation provides key advising resources for high schools,

school counselors, students, and parents to facilitate college readiness, seamless articulation,

acceleration opportunities, and ease of postsecondary transition. School counselors are encouraged

to carefully review the resources available online at the Office of Articulation website,

www.fldoe.org/articulation. These resources provide information to reduce duplication of college

credit, support informed decision‐making, and guide careful and effective academic planning for

postsecondary success.

Any student currently enrolled in a Volusia County school may apply for acceleration opportunities.

To initiate, the student’s parent or student must contact the school counselor.

Overview of Options



require statewide, standardized end-of-course (EOC) assessments. Credit will be awarded by the

district for any student who attains a Level 3 or above, as defined in s.1008.22(3)(c)5, F.S. Students

are not required to be enrolled in the course or to have completed the course. A student who is not

enrolled in the course or who has not completed the course will take the statewide, standardized

EOC assessment during the regular administration of the assessment. Any student who has not

been enrolled in a course or taken the EOC will be enrolled in the appropriate grade-level course

according to the district program of studies.

Students requesting to participate in the CAP must submit a completed Credit by Exam Request

Form to the testing coordinator and counselor at the current school of enrollment nine weeks prior to

the state-mandated testing window.

Advanced Placement Program (AP)

The College Board's Advanced Placement program is a nationwide program consisting of more than

30 college-level courses and exams in subjects ranging from art to statistics offered at participating

high schools. Students earning a qualifying score on an AP exam can earn credit or advanced

placement for their efforts. Eligibility for an AP course includes past academic performance to

support a student’s potential for advanced coursework. According to the College Board, "More than

2,900 universities and colleges worldwide grant credit, advanced placement, or both to students who

have performed satisfactorily on the exams, and approximately 1,400 institutions grant sophomore

standing to students who have demonstrated their competence in three or more of these exams"

(College Board 2000). Studies have shown that students who complete a solid academic core,

http://www.fldoe.org/articulation


14

including advanced courses, are more likely to be successful in college. Many school counselors

have found that AP courses provide the challenging content necessary to engage all types of

learners. For more information on the AP program, visit the College Board at www.collegeboard.org.

Students who earn a 3 or higher on the Advanced Placement Exam will receive high school credit for the course, regardless of their overall course grade. Students who are not enrolled in an Advanced Placement course, but wish to take the exam may do so; fees and deadlines may apply.

International Baccalaureate Program (IB)

The IB Diploma program is a rigorous pre-university course of study, leading to internationally-

standardized examinations. The program is designed as a comprehensive two-year curriculum that

allows its graduates to fulfill requirements of many different nations' education systems. Eligibility for

the IB program includes past academic performance to support a student’s potential for advanced

coursework. As with the Advanced Placement, students earning qualifying scores on IB exams are

eligible for postsecondary education credit. The award of credit is based on scores achieved on IB

exams. Students can earn up to 30 postsecondary semester credits by participating in this program at

the high school level. Approximately 40 Florida high schools currently participate in the IB program,

with the students participating at no cost. For more information on the IB program, visit the

International Baccalaureate Organization at www.ibo.org.

Early Admission

Many colleges and universities accept students after they complete their junior year (11th grade) in

high school (early admission). In other words, the student begins college without a high school diploma.

Early Admission is a form of dual enrollment that allows the student to receive a high school diploma

after successful completion of the first year of college. Daytona State College, the University of Florida,

and the University of Central Florida have early admission dual enrollment agreements with Volusia

County Schools. Early admission may be approved by the School Board when the following

requirements have been met:

The student has completed all required courses for the standard 18 or 24 credit diploma, except electives and one credit in English, ½ credit in Economics, and ½ credit in American Government.

ACT or SAT test scores have been submitted prior to the term of desired entrance. Test scores will be evaluated for entrance into the college program. Students without SAT or ACT scores may take the Post-Secondary Education Readiness Test (PERT) or Accuplacer.

The principal of the high school has recommended the student for early admission.

The student has a 3.0 or higher unweighted high school GPA.

Early Admission students will be required to take a minimum of 12 credit hours each semester. These credits must be applicable to both the high school diploma and the associate degree.

The student has been accepted by a post-secondary regionally-accredited college or university.

Students must provide their own transportation to the college campus.

The early admission student will receive a high school diploma when these conditions have been met:

The student has completed college credits to equal two semesters as determined by the college of attendance, with a normal class load, and with at least a “C” average or its equivalent.

The district has received written documentation from the college of attendance covering the college work.

A college English course consisting of two semesters, a college Economics course, and a college American Government course have been successfully completed.

NOTE: A student in the early admissions program shall not be ranked in his/her high school graduating class. Please refer to School Board Policy 307 for additional information.

http://www.collegeboard.org/

http://www.ibo.org/

15

Dual Enrollment

The State Board of Education, based on the recommendations of the Articulation Coordinating

Committee, has identified the specific dual enrollment courses that meet high school graduation

requirements and assigned a specific amount of high school credit that must be granted for each dual

enrollment course. These courses must be accepted by all high schools in Florida in accordance with

the State Board of Education list. In addition, school districts offering dual enrollment through a local

articulation agreement must provide information regarding postsecondary dual enrollment courses

that meet high school graduation requirements.

Dual enrollment allows students in grades 6-12 to enroll in postsecondary courses for which the

student earns credit towards high school graduation, while at the same time earning college credit.

Participating students are exempt from the payment of tuition and fees. Students are permitted to

enroll in dual enrollment courses on a part-time basis during school hours, after school, or during the

summer term. Early admission programs allow students to enroll in postsecondary courses full-time

on college campuses and earn credits simultaneously toward a college degree and high school

diploma.

The Dual Enrollment Guide outlines program specifics and can be viewed at:

http://myvolusiaschools.org/student-support-services/Documents/DSC%20Dual%20Enrollment%20Guide.pdf

(In process of being updated for 2016-2017)

Industry Certification Opportunities

Industry certification opportunities are offered in specific Career and Technical Education courses.

These adult level certifications allow students to leave high school with marketable skills that can

directly translate to job readiness. The state legislature works together with leaders from business

and industry to identify certifications that are relevant in today’s job market. Students have the ability

to earn certifications at no charge. In addition, successful completion of a state recognized industry

certification allows a student to earn “merit designation” upon their graduation.

Online Courses






surveys.





instruction program, a Virtual School Program, or a full-time Florida Virtual School

program.



year.

http://myvolusiaschools.org/student-support-services/Documents/DSC%20Dual%20Enrollment%20Guide.pdf

16


Courses are available for students in grades 9-12 throughout the school year and some courses are

offered during the summer. Online courses meet the needs of students who learn more productively

in their own time and in their own space. Virtual courses are added to the student’s schedule either

during or beyond the school day. Students are not required to take courses beyond the school day,

but may, if beneficial to the student’s needs. More information regarding course offerings and the

online application is available at volusiaonlinelearning.com. Counselors should contact the Online

Learning offices for enrollment assistance by calling 386-506-0014 or by contacting Wendy Ferranti

at extension 38376 or by email at [email protected].


FLVS is another option for instruction for eligible students. Approval of an FLVS course is up to the

discretion of the school and the school will add each course to the student’s schedule either during or

beyond the school day. Students are not required to take courses beyond the school day, but may, if

beneficial to the student’s needs. More information regarding course offerings is available at flvs.net.

18 - Credit Accelerated High School Option

For students entering 9th grade during the 2013-2014 school year and thereafter, an 18-credit accelerated high school option was added to the ACCEL option which allows those who meet the following requirements to be awarded a standard high school diploma:

A student must meet the high school standard diploma requirements outlined for the student’s 9th grade cohort group with the exception of the high school course and full credit in Physical Education. Students choosing the 18 credit ACCEL diploma are only required to complete three elective credits.

A student must earn a cumulative Grade Point Average (GPA) of 2.0 on a 4.0 scale.

The new 18-credit ACCEL accelerated high school graduation option replaces the college preparatory and the career preparatory 18-credit accelerated high school graduation options.

ACCEL Procedures

To explore acceleration options, the student and parent should contact the school counselor to initiate

the process of determining the student’s eligibility for each option and develop a plan for acceleration,

as appropriate. Upon notification of student/parent request for acceleration, the school counselor will:

1. review student achievement and academic performance data to establish eligibility for one or

more ACCEL options;

2. notify student of eligibility and program requirements;

3. assist student in meeting timeline and ACCEL option requirements; and

4. develop a schedule to meet student’s needs and chosen program.

http://www.volusiaonlinelearning.com/


17

CREDIT BY EXAM REQUEST FORM Volusia County Schools









___________________________ ____________________________

___________________________ ____________________________

My signature below indicates that I understand my student will be participating in the exam(s)

selected above. High school credit will be awarded for the course if my student scores a Level 3 or

above.

____________________________ _______________________________


_______________________________

Date

My signature below indicates that I understand that I will be participating in the exam(s) selected

above. If I score a Level 3 or above I will earn high school credit for the course(s) associated with the

exam(s).

____________________________ _______________________________


_______________________________

Date

This form must be completed nine weeks prior to the start of the testing window. Upon completion of

this form, the school counselor will give a copy of this completed form to the school-based testing

coordinator.

____________________________ _______________________________


_______________________________

Date


Copies: parent/guardian school based testing coordinator district testing coordinator 8/1/16