2018-2019 Parental Request for Exemption from State Assessments
Please complete this form fully. Prior to completing the form, please read the information immediately following. Your signature at the bottom of the form indicates understanding of the information.

Students who are excused from a state assessment
Will not receive a score for that assessment.
Will not have negative consequences imposed as a result of my excusal from state assessments.
Will not have standardized test scores which are frequently used to determine placement in advanced courses/programs and to identify specific instructional needs of students. If a student does not take the annual state assessments, parents/legal guardians will need to work closely with educators to make decisions supporting their child.

By completing this form your students will be excused from taking the following state assessments. I understand that this request for exemption from state assessments is valid for this school year only and applies only to the state assessments applicable to my child that I have selected below.

Email address *
Date *
MM
/
DD
/
YYYY
Student Grade *
Student ID Number *
Your answer
Student's Legal First and Last Name *
Your answer
Please indicate which test(s) you are opting your student out of for the 2018-2019 school year: *
Required
While assessments are occurring, I understand that my child will be supervised by school staff and will not be provided an alternate learning activity. *
Parent Phone number *
Your answer
Parent First and Last Name (We will also solicit verification that you submitted the excusal request)
Your answer
A copy of your responses will be emailed to the address you provided.
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