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Accommodation Waiver Form
If a student chooses not to use an accommodation listed in their Individual Education Program (IEP), 504 Plan or English Language Learner (EL) Plan, the school must have documentation that the accommodation is refused and the accommodation will still remain available during testing. Please note: certain accommodations that are previously waived may require a rescheduled time in order to ship correct materials for testing if the student chooses to add it back to the testing session
Student Name
First
Last
School
Please select
Colorado Preparatory Academy
Destinations Career Academy of Colorado
Pikes Peak Online School
Grade
Please select
Kindergarten
1st Grade
2nd Grade
3rd Grade
4th Grade
5th Grade
6th Grade
7th Grade
8th Grade
9th Grade
10th Grade
11th Grade
12th Grade
Accommodations being waived (check all that apply):
Extended Time
Small Group
Text-To-Speech/MP3
Speech-to-Text
Frequent or Multiple Breaks
Scribe
Reader
Large Print
Other
Test(s) this applies to (check all that apply):
CMAS Math
CMAS ELA
CMAS Science or Social Studies
PSAT9
PSAT10
SAT
CoAlt/DLM
Parent/Guardian Name
First
Last
Parent/Guardian Signature
Clear