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DOCUMENTATION OF "O" (Other) SCORE CODE
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NOTE: ALWAYS contact Blake or Amy in the Assessment Dept. before marking the score code as “O”. This form must be completed for every instance in which a score code of “O” (Other) is submitted. Submit this documentation to the Assessment Dept. when you return your materials. If the reason(s) for the student’s test being scored as “Other” is related to discipline/code of conduct, the “Locally Determined Disciplinary Action” document must also be completed. Retain a copy of this completed document at the testing campus for five years
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Date:Campus:
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Campus Coordinators:
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December STAAR EOC – all subject tests
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February-April TELPAS Listening/Speaking and Reading
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STAAR - Gr. 3-8 RLA
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STAAR EOC – English I and English II
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STAAR - Gr. 3-8 Math
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STAAR EOC – Algebra I, Biology, and US History
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STAAR - Gr. 3-8 Science/Social Studies
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June EOC – all subject tests
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Other (specify):
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Test Administrator:
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Monitor:
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Student Name:
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Student TSDS ID #:
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Test Booklet #:
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Reason for “Other” Score Code: Check one and complete the Description of Circumstances section below.
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LEP Postponement
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High School Equivalency Program
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Student became ill after starting the test (student was evaluated by School Nurse)
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Student has a temporary physical condition/injury and is unable to continue testing
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Test Administration Irregularity - cheating or use of electronic device for assistance (to be determined on a case by-case basis)
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Student is an unschooled Asylee/Refugee in their first year of US Schools, in grades 3-8 (not applicable to HS)
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Student is a STAAR EOC Retester who chose not to participate in the retest opportunity.
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Description of circumstances resulting in the Score Code of "Other":
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Parent notified – include date/method of notification and person contacting (No parent notification required for LEP Postponement, Foreign Exchange Student Waiver, or HSEP):
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Yes
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No
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Principal Signagure (Required)Campus Coordinator(s) Signature(s) (Required)
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