Grade: State Student ID: Provide a brief description of the accommodation for which you are requesting approval: Describe the evidence that supports the need for this accommodation, including how it is used by the student in the classroom to meet his or her English language proficiency needs: Describe the planning needed for provision of this accommodation on tests (e.g., school staff, space, and/or specialized tools or equipment needed): For SEA Use Only: Approval/Denial of Request Check one item below: This request has been approved. This request has been denied. Comments (Optional): SEA Staff Name and Position: SEA Staff Signature: Date:
Grade: State Student ID: Provide a brief description of the accommodation for which you are requesting approval: Describe the evidence that supports the need for this accommodation, including how it is used by the student in the classroom to meet his or her English language proficiency needs: Describe the planning needed for provision of this accommodation on tests (e.g., school staff, space, and/or specialized tools or equipment needed): For SEA Use Only: Approval/Denial of Request Check one item below: This request has been approved. This request has been denied. Comments (Optional): SEA Staff Name and Position: SEA Staff Signature: Date:
ACCESS-Unique-Accommodations-Request-Form.docx