AZELLA Request to Administer the Test in More than 5 Instructional Days FY2027

This additional accommodation request is for the administration of the AZELLA in more than 5 instructional days.

This is the ONLY accommodation these students require. These students are eligible for the administration of the AZELLA and their current IEPs and/or 504 Plans state that the students require additional time for state testing.

Requests must be submitted per school and may include up to 15 students per submission. You may not include multiple schools in a submission. The submission will cover both AZELLA test administrations (Placement [Dynamic Screener] and Spring Reassessment [Summative]) for the students during the current school year. This request is only valid for the current school year. If a student’s IEP or 504 Plan is updated for instruction and state assessments during the school year and after the initial submission of this form, you will need to submit a new request with the updated IEP or 504 Plan.

The submission of this request and the attestation below suffice for the provision of administering the AZELLA in more than 5 days. The AZELLA Placement (Dynamic Screener) must be administered within the compliance timeline. The administration of the Spring AzELPA Reassessment (Summative) must be completed within 10 instructional days.

Date *

Enter today's date.

Month

Day

Year

District *

District Entity Number *

School *

School Entity Number *

Enter the following information for each student at this school that this accommodation is being requested.

SSID number
Grade level
AZELLA test administration: Placement (Dynamic Screener) and/or Reassessment (Summative)
Identify whether the student has an IEP or 504 Plan

Student 1 *

Student 2

Student 3

Student 4

Student 5

Student 6

Student 7

Student 8

Student 9

Student 10

Student 11

Student 12

Student 13

Student 14

Student 15

Attest *

I attest that the current IEP(s) and/or 504 Plan(s) of the student(s) for whom I am submitting this additional accommodation request state(s) that the student(s) require(s) additional time for state testing. Upon ADE’s request, the district or charter will submit the student(s) IEP(s) or 504 Plan(s) for review. Enter your full (first and last) name.

DTC *

DTC Email *

I Consent *

NOTICE: This report (and any attachments) contains PRIVILEGED OR CONFIDENTIAL information under state and federal law. This information may be used or disclosed only in accordance with law. I confirm that I have submitted truthful information to the Arizona Department of Education that these students require additional time to administer and complete AZELLA testing per the students' current IEPs or 504 Plans for the 2026-2027 school year. I understand that the information I have provided may be shared with my District Superintendent/Charter Holder, School Principal, EL Coordinator, AZELLA District Test Coordinator, and other ADE units as necessary.