State of Israel
Ministry of Education
Pedagogical Affairs
Language Dept.
English Inspectorate
September 2013
Questionnaire for English Teachers about Students with Learning
Disabilities Requesting Level Three Testing Accommodations:
Please note: Please fill in this questionnaire if you are applying to the committee regarding
students who:

are in the tenth grade this year (2013-14)

have recommendation for accommodations for any of the following:
 an oral exam
 listening to a recording of the exam AND recording the answers
 listening to a recording of the exam for modules E and G
 recording answers for modules F and G
 ignoring spelling errors for modules F and G
Remember: Students with testing accommodations of either the oral examination or the double
accommodation of listening to a recording of the exam AND recording answers can only be tested
using the computerized exam.
The form below must be completed in its entirety for your request to be processed.
Please type the information on the form. If you are asked for a password, do not write
anything just click “OK”. When you have finished filling in the form, please print it and
sign it.
Student’s name
Student’s ID number
Name of school
Phone number of school
Fax number of school
Semel mossad
Teacher's name
Teacher's phone number
Grade
Modules being tested this year
Teacher's email
The first module will be administered in:
Year
moed
Requested accommodation:
oral exam - all modules
listening to a recording of the exam AND recording the answers for all modules
listening to a recording of the exam for modules E and G
recording answers for modules F and G
ignoring spelling errors for modules F and G
Background Information
1. What is the level of the student’s English according to the curriculum:
Foundation
Intermediate
Proficiency
2. What are your student’s challenges? (Check as appropriate.)
My student:
does not understand a text when read to.
has illegible handwriting.
cannot read own handwriting.
has multiple spelling errors making written work extremely difficult to understand.
has severe difficulty expressing him/herself in writing.
has a clear gap between oral and written skills.
has difficulty communicating orally in English.
has difficulty concentrating during class..
works extremely slowly
Other:
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3. What testing accommodations in English have been recommended for your student by the
moatsa hapedagogit at your school? (Check as appropriate.)
extra time
listening to a recording of the exam
recording answers
ignoring spelling errors
using an electronic dictionary
an oral exam / listening to a recording of the exam AND recording the answers
4. Have these accommodations been beneficial for your student?
Yes. Explain:
No. Explain:
My student has not yet tried these accommodations.
5. My student has been tested in the following way :
the conventional manner
using an electronic dictionary
having extra time
listening to a recording of the exam
spelling errors are ignored
recording answers
taking oral examination
being tested on the computer
6. What accommodations are most appropriate for your student?
7. Have you tested your student using the computerized examination? YES
8.
Is it appropriate for your student? Why or why not?
9. Please add any relevant information that will enable the committee to best evaluate which
accommodation(s) is/are appropriate for your student.
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Student Profile
Reading Skills:
In order to provide the committee with the necessary information your student’s reading skills,
please evaluate your student in two stages:
Stage One:
Ask your student to read an unseen passage (level of the text is indicated below) and answer the
relevant questions independently.
First Module to be Tested
Level of Text
A
Reading Task 4 on the 8th grade Meitzav examination
B
Longer reading passage in module A
C
Reading passage in module B
D
Reading passage in module C
E
Reading passage from old Module D examination
Stage Two:
Give your student a recording of the text to your student and have your student answer the
questions. OR have your student take the test on the computer. (It should be a different text.)
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Based on the above results, please answer the following questions:
1. When my student worked independently he/she was able to answer at least
50% of the questions correctly.
2. When my student worked independently, he/she worked extremely slowly.
Yes
No
Yes
No
Yes
No
3. When my student worked independently, he/she had extreme difficulty
staying on task and completing the assignment.
4. When my student listened to the text, he/she was able to answer at least
50% of the questions correctly.
Yes
No
5. When my student worked on the computer he/ she was able to answer at
least 50% of the questions.
Yes
No
Writing Skills
In order to provide the committee with the necessary information regarding your student’s
writing skills, please test your student in two stages:
Note: You may administer the entire test on the computer.
Stage One:
Ask your student write a composition according to the following guidelines. Your student should
use the dictionary or the electronic dictionary (if s/he has permission to do so)
First Module to be Tested
Writing Task
A
Writing task on the 8th grade Meitzav examination
B
Writing task on the 8th grade Meitzav examination
C
Writing task in module B
D
Writing task in module B
E
Writing task in the "old " module D
Please note the amount of time it took your student to complete this task.
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Stage Two:
Based on the above results, please answer the following questions:
1. My student’s answers to the reading comprehension texts are very
difficult to read and understand.
Yes
No
2. The handwriting is very unclear.
Yes
No
3. The spelling errors make it very difficult to understand
Yes
No
4. The percentage of spelling error in the answers to the questions is:
5. The student’s composition is:
comprehensible.
comprehensible, but does not reflect the student’s level of language. Explain:
is not comprehensible.
6. For five-point students only: The percentage of spelling errors in the composition is:
7. There is a marked gap between the student’s written work and his/ her recording
of the work.
Yes
No
Explain:
8. Please add any relevant information that will enable the committee to best evaluate which
accommodation(s) is/ are appropriate for your student
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Please attach ALL of the following documents:
a. The texts your student used with his/her graded written answers when working
independently. Please identify text level.
b. The texts your student used with his/her graded written answers when your student
listened to the text. Please identify text level.
c. An original copy of a composition your student wrote in class, with your corrections.
Please highlight all spelling and grammar errors and grade it according to the grading
rubrics for the Bagrut examinations.
d. A psycho-educational evaluation / an educational evaluation and a psychological
evaluation that includes an English evaluation.
After printing this form and signing it, please add it to the documents requested, above.
They, together with the student’s file, will be sent to the Vaada Machozit .
I was involved in the process regarding my students testing accommodations.
Signature: _____________________________
Date: _________________
sig
Teachers signature:__________________________ Date:______________
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