ACCOMMODATIONS/MODIFICATIONS DETERMINATION FORM
Student Name: _____________________________ School: ________________________ Date: __________________
Check (√) the box (i.e., Reader, Scribe, Paraphrasing, Extended Time, etc.) for the accommodation/ modification the ARC
is considering for the student. Address each consideration statement in the appropriate table. (703 5:070 Inclusion of
Special Populations in the State Required Assessment and Accountability Program). The form must be completed at each
annual review meeting.
Reader: (oral presentation of text:
human,
audiotape,
computerized reader)
NA
On-demand tasks (i.e., open response items, multiple-choice questions, and writing prompts) may be read to the student.
The ARC must confirm all the following in order for the student to qualify for a reader:
Yes No
The student has a verified disability which significantly impacts the area of reading;
The student’s IEP includes specific goals and objectives and specially designed instruction related to
reading or describes supplemental aids and services (e.g., large-print or Brailled text, tape recorders,
assistive or adaptive technology) necessary for the student to access, be involved in, and progress through
the general education curriculum.
Evaluation information supports the need for intervention and accommodations in the area of reading.
The student’s IEP documents the need for a “reader” to gain information and meaning from print
material as part of the student’s regular instructional routine. AND
A “reader” shall not be a replacement for reading instruction or assistive or adaptive technology
Documentation (indicate evaluations, IEP’s, conference summaries, medical statements, etc. relevant to the above
information and include their dates):___________________________________________________________________
_________________________________________________________________________________________________
Under what conditions will the student use a reader?
1. The student will use a reader for all print materials.
2. The student will use a reader when reading content material written on his/her age
appropriate grade level.
3. The student will use a reader when receiving direct instruction in the acquisition of
reading skills and strategies.
4. The student will use a reader when reading under time constraints.
Scribe (
human
software)
Yes
No
NA
A “scribe” may be used with the student. The ARC must confirm all the following in order for the student to qualify for a
scribe:
Yes No
The student has a verified disability which significantly impacts the student’s written expression or basic
writing skills, or a physical disability which impedes the motor process of writing;
The student’s IEP includes specific goals and objectives and specially designed
instruction related to writing or describes supplemental aids and services (e.g., Braille
writers, communication boards, tape recorders, assistive technology, note-taker, scribe)
necessary for the student to access, be involved in, and progress through the general
education curriculum.
The student uses a “scribe” as part of the student’s regular instructional routine to
communicate information and knowledge;
Evaluation information supports the need for intervention and accommodations in the
area of writing.
The student’s IEP documents the need for a “scribe” as part of the student’s regular
instructional routine. AND
A scribe is not being used as a replacement for writing instruction or assistive or
adaptive technology.
Documentation (indicate evaluations, IEP’s, conference summaries, medical statements, etc. relevant to the above
information and include their dates):__________________________________________________________________
________________________________________________________________________________________________
Under what conditions will the student use a scribe?
1. The student will use a scribe for prewriting activities while the student brainstorms ideas.
2. The student will use a scribe when instruction and/or classroom assessments involve a
time constraint.
3. The student will use a scribe when instruction and classroom assessments in the content
areas require a written response.
4. The student will use a scribe for all instruction and classroom assessments that require a
written response.
Paraphrasing
Yes
No
NA
On-demand tasks (i.e., open response items, multiple-choice questions, and writing prompts) may be paraphrased for the
student. The ARC must confirm all the following in order for the student to qualify for paraphrasing:
Yes No
The student has a verified disability which significantly impacts the understanding and memory of
written materials, or the student has a severe receptive language or listening comprehension deficit which
impacts the student’s ability to process oral language;
The student’s IEP includes specific goals and objectives and specially designed instruction related to
reading comprehension, language, listening comprehension or describes supplemental aids and services
necessary for the student to access, be involved in, and progress through the general education
curriculum.
The student’s IEP documents the need for paraphrasing as part of the student’s regular instructional
routine.
The student uses a “paraphraser” as part of the student’s regular instructional routine to gain information
and meaning from print material as documented in ongoing data collection. AND
A “paraphraser” is not being used as a replacement for reading, listening, or oral communication
instruction or assistive or adaptive technology.
Documentation (indicate evaluations, IEP’s, conference summaries, medical statements, etc. relevant to the above
information and include their dates):__________________________________________________________________
________________________________________________________________________________________________
Use of Technology and Special Equipment
NA
The student will use special equipment, including assistive or adaptive technology. The ARC must confirm all the
following in order for the student to qualify for the use of technology and special equipment:
Yes No
Evaluation information supports the need for intervention and accommodations in the
area of writing.
The student’s IEP documents the need for special equipment as part of the student’s
regular instructional routine. AND
The student uses the special equipment as part of the student’s regular instructional
routine as documented in ongoing data collection.
Documentation (indicate evaluations, IEP’s, conference summaries, medical statements, etc. relevant to the above
information and include their dates):___________________________________________________________________
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Extended Time
NA
The student will use extended time to complete assessments. The ARC must confirm all the following in order for the
student to qualify for extended time:
Yes No
The student’s IEP documents the need for extended time as an accommodation for assessments and
completion of assignments as part of the student’s regular instructional routine. AND
The student uses extended time as part of the student’s regular instructional routine as documented in
ongoing data collection.
Documentation (indicate evaluations, IEP’s, conference summaries, medical statements, etc. relevant to the above
information and include their dates):___________________________________________________________________
_________________________________________________________________________________________________
Reinforcement and Behavior Modification Strategies
NA
The student will need reinforcement or behavior modification strategies. The ARC must confirm all the following in order
for the student to qualify for reinforcement and behavior modification strategies:
Yes No
The student’s IEP documents the use of reinforcement or behavior modification strategies as part of the
student’s regular instructional routine. AND
The student uses reinforcement or behavior modification strategies as part of the student’s regular
instructional routine as documented in ongoing data collection.
Documentation (indicate evaluations, IEP’s, conference summaries, medical statements, etc. relevant to the above
information and include their dates)::____________________________________________________________________
___________________________________________________________________________________________________
Manipulatives
NA
The student will use manipulatives to solve problems. The ARC must confirm all the following in order for the student to
qualify for manipulatives:
Yes No
The student’s IEP documents the use of manipulatives as part of the student’s regular instructional
routine. AND
The student uses manipulatives as part of the student’s regular instructional routine as documented in
ongoing data collection.
Documentation (indicate evaluations, IEP’s, conference summaries, medical statements, etc. relevant to the above
information and include their dates):__________________________________________________________________
________________________________________________________________________________________________
Prompting or Cueing
NA
The student will need prompting or cueing strategies. The ARC must confirm all the following in order for the student to
qualify for prompting or cueing:
Yes No
Evaluation information and present level of performance supports the need for prompting or cueing.
The student’s IEP documents the need for prompting or cueing strategies as part of the student’s regular
instructional routine. AND
The student uses prompting or cueing strategies as part of the student’s regular instructional routine as
documented in ongoing data collection.
Documentation (indicate evaluations, IEP’sconference summaries, medical statements, etc. relevant to the above
information and include their dates):____________________________________________________________________
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___________________________________________________________________________________________________
Interpreter
NA
The student will need assessments to be translated to the student in sign language. The ARC must confirm all the
following in order for the student to qualify for an interpreter:
Yes No
The student has a verified disability in the area of hearing to the degree that the student’s development of
language is significantly impacted or the student uses sign language as the normal mode of
communication due to his disability.
The student’s IEP includes specific goals and objectives and specially designed instruction related to
reading, communication and language development or describes supplementary aids and services
necessary for the student to access the general education curriculum.
Evaluation information supports the need for the interventions and accommodations.
The student’s IEP documents that printed materials and oral communication used in daily instruction are
typically “signed” to the student as part of specially designed instruction or supplementary aids and
services necessary for the student to access and be involved and progress in the general education
curriculum.
“Signing” is used as part of the student’s regular instructional routine to gain information and meaning
from print material and oral communication. AND
“Signing” is not a replacement for technology or reading instruction.
Documentation (indicate evaluations, IEP’s, conference summaries, medical statements, etc. relevant to the above
information and include their
dates):________________________________________________________________________________________
_______________________________________________________________________________________________
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