LOUISIANA STATE DEPARTMENT OF EDUCATION by I14TpTUD

VIEWS: 7 PAGES: 2

									                          LOUISIANA STATE DEPARTMENT OF EDUCATION
            SECTION 504 STANDARDIZED ASSESSMENT DATA VALIDATION FORM for K-12
                         STUDENTS WITH DISABILITIES (Section 504 Eligible)

Instructions: This form must be completed and submitted to LDE after determining that students are eligible for Section 504 services
and before providing standardized testing accommodations to students who routinely receive Section 504 accommodations. LEA
Section 504 Coordinators must ensure that a copy of this form accompanies the original Individual Accommodation Plan for students
with disabilities (Section 504 Eligible). Information obtained from this form will be used for gathering statistical data for research-based
initiatives, data validation of students receiving accommodations for standardized statewide assessment, training and/or technical
assistance purposes.

        School District:_________________ School:____________________ School Code:_______Principal:_________________

        SBLC/504 Chairperson:_____________________ District Section 504 Coordinator:___________________Date:_______

        Total # of 504 Students Receiving Test Accommodations in School:___________ Total # of 504 students on site:_______

Student’s Name        Last 4 digits         Grade              Qualifying        Standardized       Accommodations Needed for Assessment
                      of student’s                             Disability         Assessment           (Codes may be used) ex. #68-Braille
                          SS #
 School District:_____________________________        School:_________________________             Page ___ of

Student’s Name       Last 4 Digits of    Grade   Qualifying    Standardized   Accommodations Needed for Assessment
                      student’s SS#              Disability     Assessment

								
To top