STAR Grade 4 Writing Transparencies Request Form

Page 1

2012 Standardized Testing and Reporting: Request for Grade FourCalifornia Modified Writing Standards TestDirections Transparencies

Note:2012STAR California Modified Writing Standards Test (CMA for Writing)directions transparencies for grade four must be kept secure and are not to be copied. CMA for Writing transparencies are to be returned to the STAR Processing Center in the box of nonscorable materials following the administration of thewriting test.

Fax this form to STAR TAC at 800-541-8455 by February 10, 2012.Transparencies will be shipped to the shipping contact listed in Part 2.

Part 1. Number of Transparency Sets Requested
Number of schools requiring transparencies:
Number of sets of transparencies:
School districts: Use Part 4 on the second page of this form to list schools and the number of sets of grade four test directions transparencies per school. List schools in the column that corresponds with the writing administration for which the transparencies are required. Requests made without a list of schools cannot be processed.

Part 2. Shipping Information

Person making the request / Telephone number
School district name orcharter school name / CDS code orcharter school code
Shipping address, line 1
Shipping address, line 2
Shipping address, line 3
Shipping contact name
District STAR Coordinator signature / Date signed
Part 3. Instructions for Distributing Transparencies
District STAR Coordinators / Test Site Coordinators
Before testing / Include with school’s shipment of test materials. Instruct test site coordinators to return to the school district with writingtest nonscorables. / Store the transparencies securely. Distribute to the appropriate fourth grade test examiner(s) on the day of testing only.
After testing / Return transparencies to the STAR Processing Centerdirectly after the writing test administrationby packing with writingtest nonscorables in the box with the red label. / Return transparencies to the district STAR coordinatordirectly after the writing test administration by packing with writingtest nonscorables in the box with the red label.
2012 STAR Request for Grade Four
CaliforniaModified Writing Standards TestDirections Transparencies
Part 4. List ofSchools

School districts:Use this page to list schools and the number of sets of CMA for Writing (Grade 4) test directions transparencies per school. Transparencies for each writing test administration will be shipped separately.

Test response transparencies are only for students who receive instruction in American Sign Language (ASL) and will have test questionspresented in ASL as designated in the student’s individualized education program (IEP) or Section 504 plan.

School District Name:
March 2012Administration ONLY / May2012 Administration ONLY
# sets / School name / # sets / School name

This form may be photocopied.