ACCESS and ALT ACCESS Irregularity Report Form (IRF)

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In the event of an unusual incident, an IRF must be completed. It is the responsibility of the Building Coordinator to complete and submit this form to WDE in addition to contacting Cat Palmer, Assessment Supervisor, at 307-777-8568. Upon receipt and review of this form, as needed, appropriate action will be taken. If you have any questions about test irregularities or this form, please contact Antoinette Hallam at antoinette.hallam@wyo.gov or (307)777-5217.

Email *

School District *

School Building Name *

School Code (7-digit numeric identifier) *

Building Coordinator Name *

Building Coordinator Contact Number *

WISER ID(s) Involved *

Subject and Grade Involved *

Date of Irregularity *

YYYY

Type of Irregularity *

Test Disruption or Interruption (e.g., fire drill,computer failure, student illness)

Test Security Related (e.g., coaching students, reviewing test questions, talking about tests)

Inappropriate Student Action (e.g., copying, student takes the wrong test,

Other

Other:

Required

Please describe the irregularity. Include evidence and details of how the incident occurred, was verified, and any action taken. Reference Section 3 of the WDE Assessment Security Guide for additional guidance. https://edu.wyoming.gov/wp-content/uploads/2022/08/Assessment-Security-Guide.pdf *

A copy of your responses will be emailed to the address you provided.

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