Test Impropriety and Irregularity Report Form

Test Impropriety and Irregularity Report Form

District Test Coordinators (DTCs) must use this form to report all potential test improprieties and irregularities to the Oregon Department of Education. DTCs must submit their initial report within one day of learning of a potential test impropriety. For more information about test improprieties and irregularities, please see the Test Administration Manual Section 3.0.

Incident Information

Date Incident Occurred

Which of the following core requirements was compromised?*

(Check one or both. See TAM Section 3.0 for definitions)

Students complete the correct test in a supervised, secure, and distraction-free test environment.

Students have access to necessary, allowable, and appropriate resources.

Did the incident result in possible IDEA non-compliance (e.g., violation of a student’s IEP)? Choose one.*

• If you select Yes below, please limit your report to one student.

• If there was an IEP violation concerning testing supports or accommodations, please indicate which ones.

Select or enter value

District Recommended Outcome*

Select or enter value

What happened, and why does the district recommend this outcome?*

• If testing supports or accommodations were involved, please specifically indicate which one(s).

• Consult Section 3.6 of the TAM for more information about improprieties, irregularities, and potential outcomes.

Student Information

SSID*

If Number of Tests Impacted is 2 or more, enter See Attached.

Enrolled Grade*

If Number of Tests Impacted is 2 or more, enter See Attached.

Select or enter value

Test Name*

Each report should concern only one test type.

Select or enter value

Result ID*

If Number of Tests Impacted is 2 or more, enter See Attached. Enter N/A for ORExt assessments.

Number of Tests Impacted

Attachments

File Upload

Use this upload field when multiple tests were impacted.

Complete the Multiple Tests Information Upload Template.
Make sure all tests in the Template match the Test Name selected above. Do not submit a Template with multiple test types.
You may include supplemental documents, such as a photo that helps illustrate the impropriety or irregularity (such as documenting instructional materials that were not removed or covered).

Drag and drop files here or

DTC Contact Information

DTC Name*

If due to reasons such as illness or absence an alternate submitter is needed, please enter the alternate submitter’s name here, with the phrase “on behalf of [DTC name]”.

DTC Email*

If an alternate submitter was needed for the reasons cited above, enter both the DTC email and the alternate submitter’s email, separated by a semicolon.

Example: dtc@district.k12.or.us; altsubmitter@district.k12.or.us

School District*

Select or enter value

School*

ODE will review this report and respond to the District Test Coordinator within 5 business days to either request additional information or confirm the outcome for all impacted tests.

Send me a copy of my responses

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