File: IKA-E - Parent Request for Exemption from State Assessments File: IKA-E - Parent Request for Exemption from State AssessmentsEast Otero School District R-1 (La Junta Schools)
20____School Year
Please complete this form and give the form to the building principal. This form is valid for the
20____ school year only.
I request that my child,_________________, be exempt from taking the following Colorado State Assessments for the 20____ school year (please mark the applicable box/boxes):
[ ] All required state assessments in the content areas of English language arts, mathematics, science, social studies and college entrance.
State assessments in the following content areas:
[ ] English
[ ] Language Arts
[ ] Math
[ ] Science
[ ] Social Studies
[ ] ACT or other standardized college entrance examination required by the state.
Reason(s) I am requesting an exemption for my child: (optional)
__________________________________________________________________________________
__________________________________________________________________________________
Please initial the following box.
I acknowledge that the school district administration has encouraged me to have my child participate in the state assessment system as a means to provide me with information concerning my child's academic progress and growth in the areas tested by the state assessment system and my child's progress toward college and career readiness.
_____________________________________ _____________________________________
Parent/Guardian Name (Please print) Student Name (Please print)
__________________________________________________________________________________
Street Address City State Zip
_____________________________________ _____________________________________
Parent/Guardian Signature Date
Adopted 2-12-18
Revised 5-14-18
Revised 2-8-21