AZELLA Special Paper Version (SPV) and Large Print (LP) Request Form Tweet AZELLA Special Paper Version (SPV) and Large Print (LP) Request Form Any request for a Special Paper Version (SPV) or large print (LP) version of the assessment must include documentation from the student’s IEP or 504 plan. This accommodation should be used routinely during instruction throughout the year and identified as an assessment accommodation. This request form is also required for Stages III – V students who are incarcerated and not permitted to use technology. A separate form should be submitted for each student. Stages I-II Large Print (LP) and Stages III-V Special Paper Version (SPV) This request form is restricted to EL/SPED students with a current IEP or 504 Plan or incarcerated students. Date* Date Format: MM slash DD slash YYYY District Test Coordinator (DTC) Name* First Last DTC Email* Name of Person Submitting Form (if other than DTC) First Last Email of Person Submitting Form (if other than DTC) District/Charter Name* District/Charter Entity Number* Student Information THIS IS A SECURE APPLICATION AND FILE SUBMISSION SITE Student SSID* Student's Current Grade Level* School Name* Request Type* IEP 504 Plan Incarcerated – Technology not permitted AZELLA Test Administration* Placement Test Spring Reassessment Test Test Type Requested* Paper – Stages III, IV, and V only Large Print (Stages I-II and SPV Stages III-V) Please Note: Braille is NOT available for AZELLA. AZELLA SPV – Stages III, IV, and V AZELLA Stage III (Grades 3-5) AZELLA Stage IV (Grades 6-8) AZELLA Stage V (Grades 9-12) AZELLA Large Print AZELLA Stage I (KG) AZELLA Stage II (Grades 1-2) AZELLA SPV Stage III (Grades 3-5) AZELLA SPV Stage IV (Grades 6-8) AZELLA SPV Stage V (Grades 9-12) File* Drop files here or Accepted file types: jpg, gif, png, tiff, pdf. For students with an IEP or 504 Plan, submit page(s) of the ACTUAL portions of the student’s official IEP or 504 plan (MUST have the student’s demographics or SSID and date of the document on each page) that indicates the need for a large print version of the test and/or that this special paper accommodation is used routinely during instruction throughout the year in lieu of computer instruction and is identified as an accommodation in place of computer-based assessment. For incarcerated students who are not allowed access to technology, upload a statement from the facility indicating that inmates are not permitted to use technology. THIS IS A SECURE FILE SUBMISSION. Allowed file extensions – .jpg,.gif,.png,.tiff,.or pdf Comments (Optional) Confirmation* I confirm that I have submitted documentation to ADE that this student requires a Special Paper Version Test for the state assessment(s).