ELL Assessment Participation Form
School Year:
Date:
Page:
of
A. District and School Information
District Name:
School Name:
LEP Committee Contact Names:
B. Student Information
Student Name:
Gender:
Student ID Number:
Country of Origin:
Grade:
Native Language:
C. LEP Status*
D. Native Language Status* E. Additional Factors*
Beginning (Level 1)
Limited
Advanced Beginning (Level 2)
Intermediate
Intermediate
(Level 3)
Strong
Early Fluent
(Level 4)
Fluent
Comments:
(Level 5)
Monitored Former LEP Student
* Refer to STEPS ONE and Two in the West Virginia Participation Guidelines, Additional Guidance for Assigning
Accommodations
PART VII: Statewide Testing (Please check all appropriate boxes)
1) Indicate the appropriate WV Measures of Academic Progress Assessment (WV-MAP) and
2) Check standard conditions or standard conditions w/accommodations.
General Assessment Grades 3-11
Alternate Assessment Grade 3-11
ACT PLAN/EXPLORE & NAEP
A) Standard Conditions
A) Standard Conditions
B) Standard Conditions w/Accommodations
B) Standard Conditions w/Accommodations
NOTE: For Alternate Assessment eligibility, the student must exhibit significant cognitive disabilities, be instructed
through Alternate Academic Achievement Standards and be pursuing a modified diploma (age 14+).
WVEIS Standard Conditions with Accommodations
Code
WVEIS Codes: P–Presentation; R–Response; T–Timing
Check all that apply
Direct Linguistic Support: * Codes in bold indicate embedded supports/accommodations.
P01
Text to speech
P02
Read aloud
P15
Have directions only read aloud
P18
Have directions rephrased by trained examiner
P23
Magnification
P24
Use electric translators to present test
P25
Use electric translators to present test directions only
P27
Use approved bilingual word-to-word dictionary for directions only
P28
Color contrast
P30
Provide translated test direction
P31
Provide translations glossary
P32
Provide translations stacked
P33
Turn off any universal tools
P37
Masking
P41
Provide translations glossary - locally provided
P42
Noise buffers
R02
Indicate responses to a scribe (multiple choice item)
R04
Indicate responses to a scribe, all elements to be scored
R15
Use a bilingual word-to-word dictionary
R17
Use an electronic translator to response
Indirect Linguistic Support: *
T03
Take more breaks (no studying)
T04
Use extra time for any timed test
T07
Use flexible scheduling, same day
T09
Provide separate setting
LEP Committee Members Signatures:
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