Alternate Assessment Assurance and Justification Survey 2021

Created for Rachel Kniager by Nhan Nguyen on 10/13/2021

Alternate Assessment Assurance and Justification Survey 2021

This survey must be completed by those corporations having more than one percent of students participate in the alternate assessment during the spring of 2021. Corporations can locate their alternate assessment participation data in the Results Driven Accountability (RDA) Planning Tool. Questions regarding this survey should be communicated to Angela Vaughn (avaughn@doe.in.gov).

All surveys must be completed no later than Friday, December 17, 2021.

Please note, the results of this survey will be publicly shared via the IDOE website.

Alternate Assessment Participation Webinar

Corporation Number/Name*

Please ensure you have selected the correct corporation as there is no way to correct this information once submitted.

Justification for why the corporation anticipates exceeding the 1 Percent Cap on Participation in the Alternate Assessment for the 2021-2022 school year (select one)*

Corporation does not anticipate exceeding the 1 Percent Cap on Participation in the Alternate Assessment for the 2021-2022 school year (explain reasoning below)Corporation has a school, community, or health program that draws a large number of families with students with significant cognitive disabilities to the area (describe or name the program and include supporting evidence below; Examples of supporting evidence include the total number of students participating and the number of students who are resident enrollments versus transfers or placements.)Corporation has small overall student population (provide overall student population and the number of students who participated in the Alternate Assessment below)Other: Corporation to provide brief justification of variables not covered in the previous options (provide justification below)

Explanation/reasoning

Assurances

1. The stakeholders selected below have watched the 2021-2022 Alternate Assessment Participation Webinar video. These stakeholders agree the appropriate students will participate in the Alternate Assessment during the 2021-2022 school year.

1. Select all that apply*

Special Education TeachersGeneral Education TeachersBuilding AdministratorsCorporation Test CoordinatorsSchool Test CoordinatorsSpecial Education Directors, Coordinators, and Assistant DirectorsSchool Psychologists

1.1- If all stakeholders have not been selected above, please explain the reasoning here.

2. The stakeholders selected below have reviewed the Alternate Assessment Participation Guidance, Flowchart, and FAQ provided on the IDOE website. These stakeholders agree the appropriate students will participate in the Alternate Assessment during the 2020-2021 school year.

2. Select all that apply*

Special Education TeachersGeneral Education TeachersBuilding AdministratorsCorporation Test CoordinatorsSchool Test CoordinatorsSpecial Education Directors, Coordinators, and Assistant DirectorsSchool PsychologistsParents of Students with Significant Cognitive Disabilities

2.1- If all stakeholders have not been selected above, please explain the reasoning here.

3. The stakeholders selected below have reviewed the 1 Percent Disproportionality Data provided by IDOE in the RDA Planning Tool. These stakeholders agree any disproportionality identified will be addressed during the 2021-2022 school year. Please note, if no disproportionalities were indicated, that option should be selected below.

3. Select all that apply*

No disproportionalities were indicatedSpecial Education TeachersGeneral Education TeachersBuilding AdministratorsCorporation Test CoordinatorsSchool Test CoordinatorsSpecial Education Directors, Coordinators, and Assistant DirectorsSchool Psychologists

3.1- If all stakeholders have not been selected above, please explain the reasoning here.

Verification

By signing below I affirm that the information provided can be verified at the request of the Indiana Department of Education.

Name*

First NameLast Name

Email Address*

Confirmation Emailexample@example.com

eSignature*