Testing Irregularity / Violation Documentation
Texas State Assessment Program
Humble ISD
All testing irregularities and violations must be documented and reported to the district testing coordinator. The campus test coordinator (CTC) should use this form to collect and record essential information for the report. Have this report in hand when you contact the district testing and research office. You will be asked to e-mail a copy of this report to the district testing coordinator and to keep a copy in a security file on campus.
Campus Information
Campus name: ______CTC: ______
Campus principal: ______Campus phone #: ______
Date of incident: ______Subject-area: ______
Test taken: T, T(A), T-M, LAT, TELPAS Grade: ______
(circle one)
STAAR EOC, FT, STAAR, STAAR M, STAAR L
Description / Sequence of Events
Name, title, and role of Name Title Role Statements each person involved / Required? Are statements required? ______
______
______
______
Where did incident occur? ______
______
What happened? ______
(outline sequence of event) ______
______
______
______
______
Why / how did incident occur?
______
______
______
Was the person(s) involved trained & oath signed? (include date of training)
______
______
What will you do to ensure this doesn’t happen again?
______
______
District Testing Office Contact
Date coordinator of Student Assessments was contacted: ______
How was incident resolved? (Check all that apply):
Student Testing CTC Response Contacts
(record date, time, response)
____ Resume test ____ Complete documentation form ____ Principal
____ Stop test ____ Keep a copy of documentation in campus ______security file ______
____ Submit documentation to Jamie Hicks ______
____ Add statements to documentation ____ Add Corrective Action Plan to Statements ____ District Director ____ File Local Disciplinary Action form online ______w/ TEA ______Mark score code as “Other” ______Provide “Other” documentation ____ Parents
______
______
______
Additional directions from director of Testing & Research:
______
Corrective Action Plan (CAP)
Did the Coordinator of Student Assessments require that a CAP be added to the principal and / or CTC’s statement? Yes ____ or No ____
List names and titles of all who will be providing a CAP: Name Title
______
______
______
Gather all documentation noted above. Statements from responsible parties should be typed, signed and submitted on campus letterhead. All statements and a copy of this form should be submitted electronically to the Coordinator of Student Assessments via e-mail to:
Completed documentation due by: ______
TESTING OFFICE ONLY
Date received: ______
Date CAP submitted to superintendent: ______
Date submitted to TEA: ______
TEA response received: ______
Response action taken: ______
Updated 8/26/2011