AZELLA Test Irregularity Report (paper tests - K-2 and K-1 SAFT)

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* required field

This AZELLA Test Irregularity Report is used to report Grades K-2 AZELLA Placement and Reassessment Test irregularities as well as the K-1 AZELLA Stand Alone Field Test irregularities. Do NOT use this form to report Lithocode exchanges or to request a new Lithocode. All requests to exchange Lithocodes between students must be submitted using the Lithocode Exchange Form. All requests for new Lithocodes must be submitted through PearsonAccess Next. Test irregularities for the 2021 Grade 2 Stand-Alone Field Test and Grades 3-12 online AZELLA tests SHOULD NOT use this form; rather, the irregularities must be submitted through PearsonAccess Next. Test Security incidents must be submitted using the Test Security and Ethics Incident Report. All AZELLA test irregularities should be reported to the Arizona Department of Education's AZELLA Team within 24 hours of the incident. This report is a secure online form.
Person Submitting Form
Name of Person Submitting Form (if other than DTC)
District or Charter Holder and Entity ID
Enter the correct and full District/Charter District name.
Do not use the school's CTDS number. It must be the Entity number. District/Charter Entity Number 9 max characters
Enter the correct and full School name.
Do not use the school's CTDS number. It must be the Entity number. School Entity Number 9 max characters
AZELLA District Test Coordinator (DTC)
AZELLA School Test Coordinator
AZELLA Test Administrator
Student Information
Once you've added the first student, you will be able to include additional students on this form. THIS IS A SECURE APPLICATION AND FILE SUBMISSION SITE
Please use the zero - "0" for Kindergarten students.
KPT does not have an assigned Lithocode.
#
If additional students need to be entered, select Yes.
Enter additional students - one line per student - SSID; Grade; Assigned Lithocode number (not for KPT)
Identify the test unit(s) that are impacted by this test irregularity. Check all that apply
Identify the test irregularities involved in this incident. Check all that apply.
Detailed Description of Incident
Enter a DETAILED description of the irregularity that is being reported.
You may attach and submit additional information as necessary. THIS IS A SECURE FILE SUBMISSION. Allowed file extensions – .pdf.,doc,.docx,.xls,.jpg,.gif,.png, or .tiff
NOTICE: This report (and any attachments) may contain 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 and documentation about an AZELLA Test irregularity to the Arizona Department of Education. I understand that the information I have provided may be shared with the District Superintendent/Charter Holder, School Principal, EL Coordinator, AZELLA District Test Coordinator, Pearson, and other ADE units as well as other State and Federal agencies as necessary.