1% Cap on the Alternate Assessment Participation Survey, 2022-23

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

Corporations must provide the following by December 19, 2022 :

Corporation Name*

Select "Other" if your Corporation is not listed.

Justification for why the corporation anticipates exceeding the 1% cap on participation in the Alternate Assessment for the 2022-23 school year. (Select one)*

Corporation does not anticipate exceeding the 1% participation cap for the 2022-23 school year (explain reasoning below)Corporation has a school, community, or health program that draws a large number of families of students with significant cognitive disabilities to area (describe or name below)Corporation has a small overall student population (provide overall population below)Other: Corporation to provide brief justification of variables not covered in the previous options

Please provide further explanation below regarding justifications.*

The stakeholders selected below have watched the Alternate Assessment Participation Webinar video. These stakeholders agree the appropriate students will participate in the Alternate Assessment during the 2022-2023 school year.

Select all the apply:*

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

If all stakeholders have not been selected, please explain reasoning here.*

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 2022-23 school year.

Select all the apply.*

Special Education TeachersGeneral Education TeachersBuilding AdministratorsCorporation Test CoordinatorsSchool Test CoordinatorsSpecial Education Directors, Coordinators, and Assistant DirectorsSchool PsychologistsParents of students with significant cognitive disabilities

If all stakeholders have not been selected, please explain reasoning here.*

The stakeholders selected below have reviewed the disproportionality data from Indiana Department of Education (IDOE). Districts found to have disproportionality will be notified by email that includes data for review. These stakeholders agree the appropriate students will participate in the Alternate Assessment during the 2022-23 school year.

Select all that apply.*

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

If all stakeholders have not been selected, please explain reasoning here.*

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

First Name

Last Name

Corporation Test Coordinator or Special Education Director Email Address*

example@example.com

Signature

1% Cap on the Alternate Assessment Participation Survey, 2022-23

Assurances