SAC Data Summary Sheet (for Assessors and Schools) Published 22 July 2016

Student Name:
School:

▼indicates a drop-down menu where one item is to be selected from the choices given.

For Level C Assessors and Psychologists: complete Tab 7 and Tabs 8-11 as needed, and save as a PDF for school application use.
For Schools:

1. Boxes enlarge as you type, and you will be able to copy and paste statements easily onto the SAC Application web pages from your saved electronic document. You may add to any comments provided by independent Level C assessors or psychologists. Underline or bold items if this finished sheet is to be printed for student files, as highlighting prints well only in colour.
2. Draft applications online may be saved and edited. Each application must be complete before it can be submitted.
3. Double-check that the student's name, NSN and DOB is correct and the same as their data in your SMS (Student Management System – KAMAR, MUSAC, etc.) as their identification data must match when an entry file is sent later in Term 1.

4. Read through the User Guide and the Help notes on each online tab for further information. The tabs required to be completed online are:

All applicants: complete Tabs 1, 2, 3, 4.

For Sensory / Medical / Physical disability add Tab 5.

For a Learning disability add Tab 6 (data from School Evidence / Alternative Evidence) or Tab 7 (data from a Level C / psychologist report), AND the Tabs for the Learning SACs (Reader: Tab 8 and 9. Computer/Writer: Tab 10 and 11. Extra Time: Tab 6 or 7, plus 9 and 11 if not already completed).

1. Applicant Academic Year: 201_

NSN: / First name: / Last name:
DOB: / Gender: / Year level:
Transfer from (if applicable): ▼
NZ curriculum level 3 4 5 6 7 8 (not NCEA level) in - English:▼ Maths:▼
(NB: Level 1 NCEA <=> NZC level 6)
Credits achieved already - Internal: External:
I understand that NZQA may amend applications, or decline late applications. Yes No
Submitter's email:

2. SAC

Select Conditions

Sensory / Medical / Physical / Learning
Vision
Hearing / Attention deficit
Autism Spectrum Depression / Anxiety Diabetes
Epilepsy
Tourette syndrome Other / Arm / Hand
Back / Leg
Head injury
DCD (Dyspraxia)
Muscular / Neurological Cerebral palsy Pregnancy / Baby care / School Evidence
or
Independent Assessment
Describe the Sensory /Medical /Physical conditions, and their ongoing impact (1000 char):

SACs Requested (consult the Documentation Requirements for the SACs possible for the various Conditions above)

Vision / Hearing / Other
Braille paper
Enlarged paper
Special paper / Signing supervisor
Signing reader / Reader
Computer OR Writer
Separate Accommodation
Extra Time
Rest Breaks
Any additional requirements or comments (if needed, Rest Beaks must be requested here if Extra Time is ticked above as well)
(1000 char):

3. Documentation

Is the documentation for the application held at the school? Yes No
If not, explain why:

4. Trials

The applicant has been using SAC successfully since: ▼now ▼unknown ▼(year/month):
If “Unknown” give reason.
SACs Trialled / Vision / Hearing / Other
None / Braille paper
Enlarged paper
Special paper / Signing supervisor
Signing reader / Reader
Computer
Writer
Separate Accommodation
Extra Time
Rest Breaks
How will the requested SAC remove barriers to achieving NCEA?: (1000char)

5. Reports (Sensory / Medical / Physical only)

Report 1 (select NA if not available) NA / Report 2 (select NA if not available) NA
Written by: / Written by:
Qualifications: / Qualifications:
Date: / Date:
Funded through the Ministry of Education (ORS, SHHNF or laptop)? Yes No

6. School Evidence

How was the applicant screened? Include tests and results: (1000 char)
Compared to an average student of the same age at the same level, the applicant's (select one for each section)
Oral language is / ▼Above average / Listening comprehension is / ▼Above average
▼Average / ▼Average
▼Below average / ▼Below average
Written language is / ▼Above average / Reading comprehension is / ▼Above average
▼Average / ▼Average
▼Below average / ▼Below average
Current and previous support offered (indicate all that apply)
None / Reading recovery / Private tutoring / RTLB
Teacher aide time / Speech/language therapy / RTLit
Reader / Computer or Writer / Extra Time
Describe the effectiveness of this support:(1000 char)
Describe the applicant’s observed need:(1000 char)

7. Independent Assessment

All dates on this screen must be no earlier than January of (the year for which you are applying minus 3)

Assessors may supply all information for the next tabs. Otherwise schools will need to extract relevant data from older reports or forms.

Report written by:
Registered as: ▼Educational psychologist ▼Psychologist ▼NZCER Level C Assessor
Date:
Psychometric Test Battery (indicate all that apply)
WIAT II / III / Woodcock-Johnson III / IV Ach
(Australian Adaption)
WAIS IV / WISC IV / V / Woodcock-Johnson III / IV Cog
SLD (indicate all that apply)
SLD reading / SLD number / SLD writing
Other (specify):
Diagnosed cobormid conditions (e.g. ADHD, ASD) if any:
Compared to an average student of the same age at the same level, the applicant's (select one for each section)
Oral language is / ▼Above average / Listening comprehension is / ▼Above average
▼Average / ▼Average
▼Below average / ▼Below average
Written language is / ▼Above average / Reading comprehension is / ▼Above average
▼Average / ▼Average
▼Below average / ▼Below average
Cognitive profile / Test (From test battery list above) / Date of testing / Result
Verbal ability / Percentile rank =
Non-verbal ability / Percentile rank =
General cognitive ability
(Select one) / ▼FSIQ ▼GIA / ▼ Percentile rank =
▼Standard Score =
Processing speed / Percentile rank =
Working memory / Percentile rank =
Is there a statistically significant difference between cognitive and academic performance? Yes No
What SACs does this Independent Report recommend?
School to complete if needed: If you requested different SACs from those recommended, explain why (1000 char):

8. Reading

NB an assessment report may be out of date but data from it may be entered here as information additional to later tests.

Comprehension (at least one) / Date / Result
Assessment report.
Test (specify): / Percentile rank =
PAT (comprehension) / Stanine =▼
YARC / Percentile rank =
DRA / Age =▼
Other (specify): / Score/Description =
Comment on reading comprehension:(1000 char)
Accuracy (at least one) / Date / Result
Assessment report.
Test (specify): / Percentile rank =
PAT (vocabulary) / Stanine =▼
YARC / Percentile rank =
DRA / Age =▼
Other (specify): / Score/Description =
Comment on reading accuracy:(1000 char)

9. Reading Speed

(also required for Extra Time applications)

NB an assessment report may be out of date but data from it may be entered here as information additional to later tests.

Test (complete at least one) / Date / Result
Assessment report.
Test (specify): / Percentile rank =
YARC / Percentile rank =
DRA / Age =▼
Other (specify): / Score/Description =
Comment on reading speed and fluency:(1000 char)

10. Spelling / Expression

NB an assessment report may be out of date but data from it may be entered here as information additional to later tests.

Spelling (complete at least one) / Date / Result
Assessment report.
Test (specify): / Percentile rank =
SAST / Spelling age = ▼
Other (specify): / Score/Description =
Comment on spelling:(1000 char)
Written and Oral Expression
Oral language.
Not Available or Test name: / Date / Result
Percentile rank =
Comment on the quality of written expression with and without a writer, and with and without a computer:(1000 char)
Comment on any discrepancy between oral and written expression:(1000 char)

11. Writing

(also required for Extra Time applications)

NB an assessment report test (DASH) may be >2 years but data from it may be entered here as information additional to PATOSS.

Test / Administered by / Date / Result
Handwriting PATOSS / words/minute =▼
Typing PATOSS / words/minute =▼
The applicant completes time-bound written language activities - / ▼Always
▼Sometimes
▼Never
Comment on handwriting skills (grip, spacing, letter formation, slope, line adherence, size, legibility):(1000 char)
Comment on writing conventions (punctuation, grammar, upper/lower case, sentences, paragraphs):(1000 char)
Upon completing and submitting the application online, upload relevant documents for the applicant:
·  Applications for a Computer / Writer requires a Patoss sample of the student’s writing. Add a sample of student assessment trialled with a Writer if the student wishes to work with a Writer.
Add a Patoss computer sample if the student wishes to use a computer.
If in doubt, upload all three.
·  the Psychologist or Level C Assessor’s report (if Tab 7 was completed)
How to upload documents:
Scan and save the sample with the student name and what it is (e.g. Jo Smith Writing Patoss) somewhere on your computer, preferably as a PDF as PDFs are more reliably uploaded in the online tool than other documents. Don't use anything in the title except letters and numbers - no dashes, no punctuation.
·  Click the applicant’s NSN on the submitted list, scroll down and click on the Documents bar.
·  Write “Jo Smith Writing Patoss” in the Document name box.
·  Click Browse.
·  Find the relevant document on your computer.
·  Click Upload.
When successfully loaded, a line appears e.g.
Jo Smith Writing Patoss submitted by (your name) on (date).
Repeat for other documents if needed.