Office of Assessment

APPENDIX A: GENERAL ASSESSMENT ACCESSIBILITY FORMS AND

DEFINITIONS

Office of Assessment

Accessibility Form A-1

Cover Page

This form applies to the following State Assessments:

Smarter ELA/Literacy and Mathematics (Summative and Interim);

DCAS Science

General Student Information:

Student Name: Click here to enter text. Date of Birth: Click here to enter text.

State ID: Click here to enter text. Grade: Click here to enter text.

School: Click here to enter text. District/Charter: Click here to enter text.

Date completed: Click here to enter a date.

Implementation Date of Accessibility Features on this form: Click here to enter a date.

☐ Student has IEP/504 plan (may use Levels 1, 2, and 3)

☐ Student is English Language Learner (may use Levels 1 and 2)

☐ Student has an IEP/504 plan AND is English Language Learner (may use Levels 1, 2 and 3)

☐ Student is a general education student with identified needs (may use Levels 1 and 2)

List below any accessibility features that have been selected for which the student needs additional

practice or preparation. Describe what practice or preparation is needed:

Accommodation

Code/ Description

Assessment/

Content Area

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Office of Assessment

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Level 1: Universal Tools (Embedded)

Level 1 Embedded Universal Tools do not have to be checked in order for a student to use the tool during testing – they are provided regardless of entry in TIDE. Non embedded Universal tools do not need to be checked either; however, a team may decide to indicate the tool below, in order to ensure that the test administrator provides these during state testing. Non-embedded universal tools MUST be provided by the test administrator on the day of testing.

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Level 1: Non-Embedded (test administrator must provide)

None ☐ ☐ ☐ ☐

Assistive listening device 3 ☐ ☐ ☐ ☐

Breaks Click here to enter text. 3 ☐ ☐ ☐ ☐

English dictionary 3 - ☐ - -

Familiar test administrator 3 ☐ ☐ ☐ ☐

Modified Lighting Click here to enter text. 3 ☐ ☐ ☐ ☐

Refocus 3 ☐ ☐ ☐ ☐

Scratch/blank/grid paper 3 ☐ ☐ Y ☐

Small group Click here to enter text. 3 ☐ ☐ ☐ ☐

Specialized equipment or furniture Click here to enter text. 3 ☐ ☐ ☐ ☐

Specified area or seating Click here to enter text. 3 ☐ ☐ ☐ ☐

Thesaurus 4 - ☐ - -

Time of Day Click here to enter text. 4 ☐ ☐ ☐ ☐

Level 1: Embedded (available through the test delivery system to all)

Breaks (see pause rules for details) 1 Y Y Y Y

Calculator (for calculator allowed items) 1 - Y - -

Office of Assessment

Digital notepad 1 Y Y Y Y

English dictionary 1 Y Y Y -

English glossary 1 Y Y Y -

Expandable passages 1 Y Y - -

Global notes 2 Y Y Y Y

Highlighter 2 Y Y Y Y

Keyboard navigation 2 Y Y Y Y

Mark for review 2 Y Y Y Y

Math tools 2 - - Y -

Spell check 2 Y Y Y Y

Strikethrough 2 Y Y Y Y

Writing tools 2 Y Y Y Y

Zoom 2 Y Y Y Y

Y indicates already provided to all students during the test administration

- indicates not available for this content area

Office of Assessment

NOTE - throughout this document the Content Areas refer to the following:

Smarter ELA = For the summative, this refers to the English Language Arts CAT (Computer Adaptive Test);

for the interim this refers to the English Language Arts portions that are NOT the ELA-PT

Smarter ELA-PT = English Language Arts - Performance Task

Smarter Mathematics = For the summative, this refers to the Mathematics CAT and PT; for the interims it

applies to all Mathematics assessments

DCAS Science = Refers to all DCAS Science Assessments

Level 2: Designated Supports (Embedded)

Level 2 supports are available to: - General Education Students who receive extra supports - English Learners - Students with disabilities (IEP and 504) - English Learners with disabilities

Embedded - when entered into TIDE, they will be available to the student within the test delivery system. P

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No Embedded Designated Supports Selected (none) ☐ ☐ ☐ ☐

Color Choices: (black on white = default) Select a color choice. 5 ☐ ☐ ☐ ☐

None 5 ☐ ☐ ☐ ☐

Yellow background 5 ☐ ☐ ☐ ☐

Blue background 5 ☐ ☐ ☐ ☐

Light Yellow background 5 ☐ ☐ ☐ ☐

Black text on Rose background 5 ☐ ☐ ☐ ☐

Light Magenta background 5 ☐ ☐ ☐ ☐

Gray background 5 ☐ ☐ ☐ ☐

Light Gray background 5 ☐ ☐ ☐ ☐

Green background 5 ☐ ☐ ☐ ☐

Light Green background 5 ☐ ☐ ☐ ☐

Yellow text on Blue background 5 ☐ ☐ ☐ ☐

Medium Gray text on Light Gray background 5 ☐ ☐ ☐ ☐

Reverse Contrast (white text on black background) 5 ☐ ☐ ☐ ☐

Masking 5 ☐ ☐ ☐ ☐

Permissive Mode 5 ☐ ☐ ☐ ☐

Zoom: √ one: ☐1x ☐1.5x ☐ 1.75x ☐2.5x ☐3x ☐5x ☐10x ☐

15x ☐ 20x

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Streamlined Mode 6 ☐ ☐ ☐ ☐

Text to Speech

Passages & Stimuli & Items 7 - ☐ ☐ ☐

Items 7 ☐ - - -

Passages (DOE Approval Needed) 7 ☐ - - -

Language 7 Spanish (Level 2 support) 7 - - ☐ ☐

Office of Assessment

Level 2 supports are available to: - General Education Students who receive extra supports - English Learners - Students with disabilities (IEP and 504) - English Learners with disabilities

Embedded - when entered into TIDE, they will be available to the student within the test delivery system. P

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Online Refreshable Braille (Level 3 accommodation) 7 ☐ ☐ ☐ ☐ Glossaries – online – including English

For ELA, the only choice is English glossary. 8

No Glossary 8 ☐ ☐ ☐ -

English 8 ☐ ☐ ☐ -

Arabic 8 - - ☐ -

Cantonese 8 - - ☐ -

Filipino 8 - - ☐ -

Korean 8 - - ☐ -

Mandarin 8 - - ☐ -

Punjabi 8 - - ☐ -

Russian 8 - - ☐ -

Spanish 8 - - ☐ -

Ukrainian 8 - - ☐ -

Vietnamese 8 - - ☐ -

Arabic & English 8 - - ☐ -

Cantonese & English 8 - - ☐ -

Filipino & English 8 - - ☐ -

Korean & English 8 - - ☐ -

Mandarin & English 8 - - ☐ -

Punjabi & English 8 - - ☐ -

Russian & English 8 - - ☐ -

Spanish & English 8 - - ☐ -

Ukrainian & English 8 - - ☐ -

Vietnamese & English 8 - - ☐ -

- indicates not available for this content area

Office of Assessment

Level 2: Designated Supports (Non-Embedded)

Level 2 supports are available to: - General Education Students who receive extra

supports - English Learners - Students with disabilities (IEP and 504) - English Learners with disabilities

Non-embedded supports MUST be provided by the test administrator on the day of testing.

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No Non-Embedded Designated Supports selected (none) ☐ ☐ ☐ ☐

Select All

Bilingual dictionary 9 - ☐ - ☐

Disable universal tools (in TA interface) 8 ☐ ☐ ☐ -

EL 1st year Exemption 14 ☐ ☐ - -

Translations (glossaries) - paper/pencil 10 - - ☐ -

Noise buffers 10 ☐ ☐ ☐ ☐

Paper/Pencil test # 10 ☐ ☐ ☐ ☐

Separate Setting in school 9 ☐ ☐ ☐ ☐

Separate Setting not in school/homebound 9 ☐ ☐ ☐ ☐

Simplify directions in English* 16 ☐ ☐ ☐ ☐

Simplify directions in native language 16 - - - ☐

Interpret/translate orally - directions only 17 ☐ ☐ ☐ ☐

Interpreter - native language (approval by DOE)** 12 - - ☐ ☐

WhisperPhone 15 ☐ ☐ ☐ ☐

Color Contrast (printed) 9 ☐ ☐ ☐ ☐

Color overlays 9 ☐ ☐ ☐ ☐

Scribe for EL or Gen Ed 9 ☐ ☐ ☐ ☐

Magnification (via external device) 9 ☐ ☐ ☐ ☐

Human Read Aloud 11

Items ONLY 11 ☐ - - -

Passage/Stimuli & Items† 11 † ☐ ☐ ☐

Spanish 12 - - ☐ ☐ Translated test directions in print 10 ☐ ☐ ☐ -

Unique accommodation (approval by DOE) 12 ☐ ☐ ☐ ☐

- indicates “not available for this content area”

* For Smarter ELA and Math, simplified directions will be provided via download on the DeSSA Portal.

** Select in the “Special Request” section of the TIDE student settings screen.

† Select in the “special Request” section of the TIDE student settings screen for Smarter ELA. Mark in

Level 3: Accommodations – Embedded, on page 6. # Use this flag for homebound students taking paper-pencil, in addition to EL, SWD, and GenEd with

Supports students.

Office of Assessment

Level 3: Accommodations (Embedded)

Level 3 accommodations are available to: - Students with disabilities (IEP and 504) - English Learners with disabilities

Embedded Accommodations - when entered into TIDE, they will be available to the student within the test delivery system.

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No Embedded Accommodations Selected (None) ☐ ☐ ☐ ☐

American Sign Language Video 4 ☐ ☐ ☐ -

Type of Refreshable Braille (also need to check “Language: Braille” in Level 2: Embedded above)

Contracted 4 ☐ ☐ - -

Uncontracted 4 ☐ ☐ - -

Nemeth 4 - - ☐ -

Closed Captioning 4 ☐ ☐ - -

Text to Speech - Passage/Stimuli & Items† 7 ☐ - - -

Emboss (use w/refreshable Braille) (passages/stimuli and items) 5 ☐ ☐ ☐ -

Emboss type (use w/refreshable Braille) 5

Not Applicable (not using Refreshable Braille) 5 ☐ ☐ ☐ -

On-Request 5 ☐ ☐ ☐ -

Auto-Request 5 ☐ ☐ ☐ -

Print on Request 5

Passage/Stimuli & Items 5 ☐ ☐ ☐ ☐

Passage/Stimuli 5 ☐ - - -

Items 5 ☐ - - -

† Select in the “Special Request” section of the TIDE student settings screen for Smarter ELA.

Office of Assessment

Level 3: Accommodations (Non-Embedded)

Level 3 accommodations are available to: - Students with disabilities (IEP and 504) - English Learners with disabilities

Non-embedded supports MUST be provided by the test administrator on the day of testing.

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No Non-Embedded Accommodations Selected (None) ☐ ☐ ☐ ☐

Abacus 12 - - ☐ -

Alternate response* 13 ☐ ☐ ☐ ☐

Arithmetic Tables 15 - - - ☐

Braille (Paper/Pencil version) 14 ☐ ☐ ☐ ☐

Calculator (calculator portion only) – handheld adaptive calculator 13 - - ☐ -

Chunking/highlighting 15 - - - ☐

Graphic organizer 16 - - - ☐

Human Read Aloud – passages (approval by DOE)† 11 ☐ - - -

Hundreds Table 13 - - ☐ -

Interpreter - Visual Communication (Approval by DOE) 17 - - ☐ -

Instructions/items on overhead projector/whiteboard 14 - - - ☐

Math manipulatives 15 - - - ☐

Multiplication Table (grade 4 and up) 13 - - ☐ -

Physical assistance from a test administrator 8 ☐ ☐ ☐ ☐

Respond via whiteboard 16 - - - ☐

Scribe for SwD 10 ☐ ☐ ☐ ☐

Signed directions 14 - - - ☐

Speech to Text** 13 ☐ ☐ ☐ -

TA acts as ASL to English Dictionary 15 - - - ☐

Word processor or similar device 16 - - - ☐

† Select in the “Special Request” section of TIDE student setting screen.

* Includes, but, is not limited to adapted keyboards, large keyboards, StickyKeys, MouseKeys, Filter Keys,

adapted mouse, touch screen, head wand, and switches.

** Must be used with Permissive Mode (see Level 2 embedded: designated supports). Requires local

installation of speech-to-text software.