Limited English Proficient
Winston-Salem/Forsyth County Schools
LEP Modifications/Accommodations Form
Revised 8/28/14
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) ______
Content/ClassroomTeacher ______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.)
Revised 8/28/14
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
______using alternative assessments of progress ______assessing per proficiency level
______providing visual representations ______providing scaffolded instructional supports
______use of Home Language, as needed ______provide assignments in advance
______preview reading materials before lessons ______dictate to scribe
______simplified assignments ______grading per effort & progress
______collaborating with ESL teacher in grading decisions
______other - explain ______
English as a Second Language Services:
Is this student receiving English as a Second Language (ESL) services?
Yes ______ Level 1 or 2 (Active) ______Level 3 (Consultative)______
No ______
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This student is required to take the following NC standardized test(s) during the ______school year.
Read ______North Carolina Beginning of Grade (BOG - 3rd Grade)
______Read to Achieve (Grade 3)
Read ______Math _____ North Carolina End-of-Grade Test (Grades 3-8)
______North Carolina End-of-Grade Science Test (Grade 5 and 8)
______EXPLORE (Grade 8)
______READY Biology EOC
______READY English II
______READY Math I
______Field Tests (NC Field Test, NAEP, TIMSS)
______PSAT ______SAT
______PLAN (Grade 10) ______ACT (Grade 11)
______Career and Technical Education Post Assessments (Please list.)
______
______NC Final Exams (Please list subjects.)
______
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Additional Testing Notes regarding this student (if necessary):