DATE OF REQUEST: ____________________
STUDENT'S NAME: ___________________________________________________________
SCHOOL: ___________________________________________________________________
GRADE LEVEL: ______________________________________________________________
TEST BEING OPTED OUT:
___ CMAS (Colorado Measures of Success) DLM Mathematics Assessment
___ CMAS (Colorado Measures of Success) DLM English Language Arts Assessment
___ CMAS/CoAlt Science Assessment
___ CMAS/CoAlt Social Studies Assessment
___ College Proficiency Screener/Exam (e.g. PSAT/SAT)
REASON FOR OPTING OUT OF THE TEST:
__________________________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________
INFORMATION OF PARENT/GUARDIAN REQUESTING THE OPT-OUT
PARENT/GUARDIAN NAME: _________________________________________________________
CONTACT NUMBER/EMAIL: _________________________________________________________
I understand that by opting my child out of the test(s) indicated above, that the following may result:
• My child's school's overall performance results may be impacted at the local, state and federal level.
• My child will not have performance or growth data to demonstrate how he/she is performing as compared to others in the school, district, state or nation.
• My child will not have growth data to demonstrate how he/she is learning across school years.
_____________________________________ ______________________________________
PARENT/GUARDIAN SIGNATURE SCHOOL PRINCIPAL SIGNATURE
_________________ DATE RECEIVED BY DISTRICT ASSESSMENT DEPARTMENT
Revised March 12, 2020