AZELLA Additional Accommodation to Administer the Test in over more than 5 Instructional Days

This is a request for the additional accommodation of administering the AZELLA in over more than 5 instructional days. This is the ONLY accommodation needed for these students. These students are eligible for the administration of the AZELLA and have current IEPs or 504 Plans.

This request must be submitted by school and for up to 10 students per submission. You may not include multiple schools. The submission, per school, will cover both AZELLA test administrations (Placement and Spring Reassessment) for the students during the current school year. This request is only valid for the current school year. If the student’s IEP or 504 Plan is updated for instruction and state assessments during the school year and after this initial submission, you will need to submit a new request with the updated IEP or 504 Plan.

There are no provisions, in either state or federal law, that would allow the exemption of AZELLA testing for eligible students who are enrolled in the Special Education program and require an AZELLA test. An IEP Team, which must include an expert in second language acquisition, may NOT exempt a student from participating in AZELLA testing.

The additional accommodation requested in this form must be included in the accommodations for instruction, district assessments, and state assessments section of the student's IEP or 504 Plan. Accommodations specific for AZELLA should also be included in the student's IEP or 504 Plan. This request must be accompanied by supporting documentation pages extracted from the student's IEP or 504 Plan. If any of the students IEPs or 504 Plans are updated for instruction and state assessments during the school year and after this initial submission, you will need to submit a new request for those students with the updated IEP or 504 Plan.

The submission of this request form does not constitute an approval for the additional accommodations being requested. ADE will review the request and then ADE will provide a response to the AZELLA District Test Coordinator that includes approval, denial, or a request for additional information for the students in which the accommodation being requested. The entire review process may take up to 2 calendar weeks from the date of submission provided that the required documentation is submitted in the original request or additional information is submitted in a timely manner upon ADE's request. The student(s) may NOT begin AZELLA testing until ADE's response indicates to proceed with the administration of the AZELLA test.

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 and/or Reassessment)
IEP or 504 Plan

Student 1 *

Student 2

Student 3

Student 4

Student 5

Student 6

Student 7

Student 8

Student 9

Student 10

DTC *

DTC Email *

Attest *

I attest that the student(s) for whom I am submitting this request is ONLY for the additional accommodation of administering the AZELLA test in over 5 instructional days. These students do NOT require any other additional accommodations.

Yes

Not Applicable

File Uploads

You must submit page(s) of the ACTUAL sections (not the entire IEP/504 Plan) of the student’s official IEP or 504 plan that indicate the additional accommodation for the test to be administered in over more than 5 instructional days. "AZELLA" State Test (Grades K-12) must be identified in the State Assessment section of the IEP/504 Plan. These pages must have the student’s demographics or SSID and the date of the document on each page submitted. Do not submit the entire IEP or 504 Plan.

THIS IS A SECURE FILE SUBMISSION.

Allowed file extensions – .pdf., .doc, .docx

Use the "Choose File" to add your file(s) securely to the request. The file(s) will be sent to ADE after the request is submitted.

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 and documentation to the Arizona Department of Education that this student requires additional AZELLA testing accommodations per the student’s IEP or 504 Plan for the current 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.