AZELLA Test Security and Ethics Incident Report FY22

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This AZELLA Test Security and Ethics Incident Report is used to report AZELLA test security and ethics violations before, during, and after AZELLA test administrations for the current fiscal year.


All AZELLA test security and ethics violations must be reported to the Arizona Department of Education's AZELLA Team within 24 hours of the incident. This report is a secure online form. ADE will respond within 2 full business days of the submission.

Person Submitting Form
Enter the full name of the person submitting this report. You must include a first name and a last name. Do not enter abbreviations for the first and last name.
Enter the best telephone number to reach you should ADE need to call you in regard to this submission.
District and School Information
Enter the correct and full District or Charter Holder name. Do not use an acronym.
Enter the District Entity number. Do not use the CTDS number.
Enter the correct and full SCHOOL name. Do not use acronyms.
Enter the School Entity number. Do not use the CTDS number.
AZELLA Staff
Enter the full names for each person. You must enter a first name and a last name. Do not enter abbreviations for the first and last name.
Enter the full name of other people other than the DTC, STC, and TA, that were involved or witnessed this incident. You must enter first and last names. Do not enter abbreviations for the first and last names. Separate names by a comma.
For all students involved in this report, please enter their SSIDs and Grade Levels on separate lines. SSID xxxxxxxx; Grade X
Identify the test security and ethics violations 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, .xlsx, .jpg, .gif, .png,
Consent
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.