Limited English Proficient
Winston-Salem/Forsyth County Schools
LEP Modifications/Accommodations Form
School Use: Copy placed into
cumulative folder. Copy sent home
to parent/guardian.
ENGLISH VERSION
Parent Information: In order to provide the best possible instruction for your child, these LEP testing
modifications will be used consistently with this student during the _______________ academic year. Please contact
your child's school if you have questions about these LEP instructional and testing accommodations.
LEP Committee Information: Complete this document yearly for each LEP student who will be using LEP
modifications in the mainstream classroom and on North Carolina standardized assessments. This form is only for
LEP students. If you have a question about whether a child is LEP, please consult your school's ESL teacher or
Testing Coordinator. Students are designated as LEP based on an initial W-APT score and English language
proficiency levels or an annual ACCESS for ELLs® score and English language proficiency levels. LEP
accommodations must be used consistently in the mainstream classroom in order to be used on North Carolina
standardized assessments.
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Student's Name ____________________________________
Student Identification # ___________________
Grade ____ Subject(s) __________________________________________________________________________
Teacher __________________Teacher Signature ______________________________date ________________
LEP Committee Members
Printed Name _______________________________________ Signature _____________________________________
Printed Name _______________________________________ Signature _____________________________________
Printed Name _______________________________________ Signature _____________________________________
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Testing Accommodations for Limited English Proficient Students
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The following North Carolina LEP testing accommodations will be used when this student takes state mandated
assessments (not available for the ACCESS for ELLs or WAPT unless documented in IEP).
__________ Test administrator (or Computer) reads tests aloud in English (cannot be used for any Reading
assessments or English 2).
____ Upon Request
____ Entire Assessment
__________ Schedule extended time
Specify extended time _________________________________________________
__________ Student reads tests aloud to self ________________________________________________
__________ Student uses multiple test sessions
Details regarding multiple test sessions __________________________________
__________ Student tests in separate room
__________ Allowing use of English/Native Language Dictionary or Electronic
Translator* (*If electronic translator has a calculator, the calculator must be
deactivated or the electronic translator must be collected prior to the
"calculator inactive" portion of any assessment.)
8-12-13
Check the LEP instructional modifications that the student is using consistently in class.
__________ take home tests
__________ classroom buddy/mentor
__________ reduced homework
__________ simplified tests
__________ providing copies of class notes
__________ allowing extra time for tests
__________ allowing extra time for assignments/projects
__________ eliminating essay questions
__________ other - explain _____________________________________________________________
English as a Second Language Services:
Is this student receiving English as a Second Language (ESL) services?
Yes __________
No __________
How often is the student receiving ESL services?
Once a Week _________ More than once a week _________
Less than once a week ________
Is the student's English proficiency interfering with comprehension of course or class content?
Yes__________
No __________
Does the student have the same assignments/tests as other English proficient students in the class?
Yes __________
No __________
Is the student evaluated by the same standards as other students who are not LEP?
Yes __________
No __________
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This student is required to take the following NC standardized test(s) during the __________ school year.
Read ______ Math _____ North Carolina Beginning of Grade (BOG - 3rd Grade)
Read ______ Math _____ North Carolina End-of-Grade Test (Grade 3)
Read ______ Math _____ North Carolina End-of-Grade Test (Grade 4)
Read ______ Math _____ North Carolina End-of-Grade Test (Grade 5)
Read ______ Math _____ North Carolina End-of-Grade Test (Grade 6)
Read ______ Math _____North Carolina End-of-Grade Test (Grade 7)
Read ______ Math _____North Carolina End-of-Grade Test (Grade 8)
___________North Carolina End-of-Grade Science Test (Grade 5)
___________North Carolina End-of-Grade Science Test (Grade 8)
__________ READY Biology EOC
__________ READY English II
__________ READY Algebra I/Integrated I (possibly aka. Math I)
__________ Career and Technical Education Tests (please list)
__________________________________________________________________
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Additional Testing Notes regarding this student (if necessary):
8-12-13