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pdfTHE NATIONAL ASSESSMENT OF
EDUCATIONAL PROGRESS
Wave 2 Submittal for 2011
VOLUME II
Part 4g
SD Worksheet
FOR 2011 ASSESSMENT
for Puerto Rico
Part 4g contains:
SD Worksheet (Puerto Rico Administration)
The amount of time estimated to complete the corresponding SD form is 10 minutes per student.
June 2, 2010
A
Student Name
B
C
Session # /
Line #
D
(Column "O" on Admin. Schedule)
NAEP Student Booklet ID #
E1
E2
How is this student included in your state test
of the NAEP subject listed in column B?
1 = Without Accommodations
(Go to column H)
2 = With Accommodations (Go to column G)
3 = With Modified Assmt (Go to column G)
4 = With Alternate Assmt (Go to column H)
NAEP 2011
Students with Disabilities (SD) Worksheet
Puerto Rico
SCHOOL COPY
of
Page
F
G
What accommodations does this student receive on
your state test for the NAEP subject listed in
column B?
Refer to the enclosed State-specific SD Guidelines
Summary for more information on the accommodations
for SD students allowed by your state.
H
I
How should this student be tested on NAEP?
1 = Without Accommodations
2 = With Only NAEP Allowed Accommodations
3 = Do Not Test
Pearson Use Only
If this student's SD classification has changed
from column E1, record the student's current
SD classification using one of the codes listed
below.
1 = Has an IEP for a disability
2 = Has a Section 504 Plan and needs
accommodation to be tested
3 = Not SD or Section 504 Plan (Do not complete the rest of the worksheet for this student)
Page
perf
NAEP 2011
Students with Disabilities (SD)
Worksheet
In the fall, this student's SD classification was
reported as: 1 = Has an IEP for a disability
NAEP Subject
M = Mathematics
Inv. #NA00017358
This form must be completed in No. 2 pencil.
Please complete both sides of this
worksheet for each student.
SCHOOL #:
School Name:
of
Please complete the back of this worksheet for each student.
For
NAEP
Use Only
Student Name
NAEP 2011
Students with Disabilities (SD)
Worksheet
School Copy
Session # /
Line #
NAEP Student Booklet ID #
Autism
Traumatic brain injury
Orthopedic impairment
Emotional disturbance
Page
M
of
N
Which of the following IDEA categories best describes this student's identified disability(ies)?
(Fill in all ovals that apply)
Other health impairment (specify)
183158-001:321
What is the degree of this student's disability(ies)?
1 = Profound/Severe
2 = Moderate
3 = Mild
At what grade level does this student perform in the NAEP
subject listed in column K?
1 = At or above grade level
2 = One year below grade level
3 = Two or more years below grade level
4 = Not receiving instruction in this subject
5 = Don't know
of
Other health impairment
(Record the other health impairment in the space to
the right)
Developmental delay (age 9 or younger)
(Column "O" on Admin. Schedule)
Mental retardation
L
Visual impairment/blindness
K
Hearing impairment/deafness
J
Specific learning disability
NAEP Subject
M = Mathematics
Page
SCHOOL #:
O
Printed in the USA by Pearson
P
ISD8962
THE NATIONAL ASSESSMENT OF
EDUCATIONAL PROGRESS
Wave 2 Submittal for 2011
VOLUME II
Part 4h
SD Worksheet Instructions
FOR 2011 ASSESSMENT
for Puerto Rico
Part 4h contains:
SD Worksheet Instructions (Puerto Rico Administration)
The amount of time estimated to complete the corresponding SD form is 10 minutes per student.
June 2, 2010
National Assessment of Educational Progress (NAEP)
Instructions for Completing Worksheets for Students with Disabilities (SD)
(Please review these instructions before completing the SD Worksheets)
Frequently Asked Questions
What information is collected on the SD Worksheets?
The SD Worksheet records
how each SD student is assessed in the state academic assessment in the NAEP subject the student is
selected to take (front of the worksheet),
whether each student can participate in NAEP with the accommodations allowed for the NAEP subject
(front of the worksheet), and
each student’s disabilities and grade-level performance (back of the worksheet).
School personnel will make the final determination on how SD students are included in the
NAEP assessment.
If you need clarification for completing the worksheet, please contact your NAEP state
coordinator (public schools) or your NAEP representative (private schools).
Who should complete the worksheet?
The person completing the front of the worksheet should be the person at your school most knowledgeable
about how the student is tested in the state academic assessment in the subject listed in column B on the front
of the worksheet.
For example, if the NAEP subject listed is “M” for mathematics, the person completing the worksheet
should know how the student is tested in the state academic assessment in mathematics.
This person may be a school testing or IEP coordinator, a special education or classroom teacher.
The person completing the back of the worksheet should be the person at your school most knowledgeable
about the student’s disabilities and grade-level performance.
What if an SD student is withdrawn or graduated, never attends campus (e.g., homeschooled),
or is otherwise ineligible for NAEP (e.g., not enrolled in the sampled grade)?
Draw a line through that student’s name, record a note in column G and leave the rest of the
worksheet blank for that student.
What should I do with the worksheet(s) when I’m finished?
Return all completed worksheets to the NAEP school coordinator by the date requested.
If you are the school coordinator, put the completed worksheets in the NAEP Storage Envelope. Your
NAEP representative will collect them at the preassessment visit.
According to the Paperwork Reduction Act of 1995, no persons are required to respond to a
collection of information unless such collection displays a valid OMB control number. The valid
OMB control number for this information collection is 1850-0790. The time required to complete
this information collection is estimated to average 10 minutes per student including the time to review
instructions, search existing data resources, gather the data needed, and complete and review the
information collection. If you have any comments concerning the accuracy of the time
estimate(s) or suggestions for improving this form, please write to: U.S. Department of
Education, Washington, D.C. 20202-4537. If you have comments or concerns regarding the
status of your individual submission of this form, write directly to: NAEP/NCES, U.S.
Department of Education, 1990 K Street N.W., Washington, D.C. 20006-5651.
1
A project of the National Center for Education Statistics (NCES), Institute of Education Scienc
U.S. Department of Education. The information you provide will be
used for statistical purposes only. In accordance with the Confidential Information
Protection provisions of Title V, Subtitle A, Public Law 107-347 and other
applicable Federal laws, your responses will be kept confidential and will not be
disclosed in identifiable form to anyone other than employees or agents. By law,
every NCES employee as well as every agent, such as contractors and NAEP coordinators,
has taken an oath and is subject to a jail term of up to 5 years, a fine of up to $250,000,
or both, if he or she willfully discloses ANY identifiable information about you.
OMB No. 1850-0790 • Approval Expires 04/30/2013
Mark Reflex® forms by Pearson NCS EM-17XXXX-001:654321
Page 2 of 4
Completing the Front of the Worksheet
Columns A through E1 are pre-printed.
Columns E2 through H are completed by school staff.
Column I is For NAEP Use Only.
Column E2: If this student’s SD classification has changed from column E1, record the student’s
current SD classification using one of the codes below.
Codes for Column E2
1 = Has an IEP for a disability
2 = Has a Section 504 Plan and needs accommodation to be tested
3 = Not SD or Section 504 Plan (Do not complete the rest of the worksheet for this student)
Column F:
How is this student included in your state test of the NAEP subject listed in column B?
Codes for Column F
1 = Without Accommodations (Go to column H)
2 = With Accommodations (Go to column G)
3 = With Modified Assessment (Go to column G)
4 = With Alternate Assessment (Go to column H)
Column G:
What accommodations does this student receive on your state test for the NAEP subject
listed in column B? Refer to the enclosed State-specific SD Guidelines Summary for more
information on the accommodations for SD students allowed by your state.
The following are not allowed on NAEP for any grades or subjects:
Abacus/tables/graph paper
Tape recording answers
Taking NAEP over multiple days
Dictionary/thesaurus/spelling/grammar software
Questions reworded or simplified
Column H:
How should this student be tested on NAEP?
To answer column H, review your State-specific SD Guidelines Summary for information on your state's
inclusion policy.
Codes for Column H
1 = Without Accommodations
2 = With Only NAEP Allowed Accommodations
3 = Do Not Test
Turn to Page 4 of these instructions for more information on how to complete the back page of
the SD Worksheet for each student listed.
Page 3 of 4
Completing the Back of the Worksheet
On the back of the worksheet are some research questions for the same students listed on the front. Please
consult the person most knowledgeable about each student’s disabilities and grade-level performance to
answer these questions.
Columns J through M are pre-printed.
Columns N through P are completed by school staff.
Column N
Which of the following IDEA categories describes this student’s identified disability(ies)?
Fill in one or more ovals indicating all of each student’s identified disabilities. The categories listed are used
by the Individuals with Disabilities Education Act (IDEA).
Column O
What is the degree of this student’s disability(ies)?
Record the degree of each student’s disability(ies) recorded in column N, using one of the following codes:
1 = Profound/Severe
2 = Moderate
3 = Mild
The response should be based on the knowledge of the person most familiar with how the degree of this
student’s disability(ies) compare(s) to other students with the same disability(ies) in the same grade.
Column P
At what grade level does this student perform in the NAEP subject listed in column K?
Record the grade level at which the student performs in the NAEP subject listed in column K, using one of
the following codes:
1 = At or above grade level
2 = One year below grade level
3 = Two or more years below grade level
4 = Not receiving instruction in this subject
5 = Don’t know
For example, a fourth-grade student selected to take the NAEP math assessment who performs at a secondgrade level should be marked as code 3 (two or more years below grade level).
Page 4 of 4
| File Type | application/pdf |
| File Modified | 2010-06-21 |
| File Created | 2010-05-20 |