Assessment Forms

DAC and DTC Update Forms

DAC Update Form - This form must be completed every year by District Assessment Coordinators (DACs) to assure that DPI has the most recent contact information for updates via mail or email.

DTC Update Form - This form must be completed every year by District Technology Coordinators (DTCs) to assure that DPI has the most recent contact information for updates via mail or email.

Confidentiality Forms

DAC Confidentiality Form – (forms function best using chrome browser) The DAC confidentiality form must be completed by the designated district assessment coordinator each school year. The DAC Confidentiality Form encompasses all (Forward, ACT/PreACT Secure, DLM, ACCESS for ELLs) state assessments. Once completed, this form should be sent to osamail@dpi.wi.gov.

The following forms must be completed by the appropriate staff each school year. Once completed, these forms should be retained at the district/school level.

Forward Confidentiality forms - A confidentiality form must be completed by anyone who works with or views the Forward Exam testing materials or reports.

• Forward SAC Confidentiality Agreement
• Forward DTC Confidentiality Agreement
• Forward STC Confidentiality Agreement
• Forward TA/Proctor Confidentiality Agreement
• Forward District/School Report User Confidentiality Agreement
• Forward Exam Read Aloud Protocol - Agreement to Maintain Security & Confidentiality

ACT/PreACT Secure Confidentiality forms - A confidentiality form must be completed by anyone who works with or views the ACT/PreACT Secure testing materials or reports.

• ACT SAC Confidentiality Agreement form
• ACT Test Coordinator Confidentiality Agreement form
• ACT Room Supervisor/Test Administrator/Proctor Confidentiality Agreement form
• ACT DTC/STC Confidentiality Agreement form

DLM Confidentiality forms - A confidentiality form must be completed by anyone who works with or views the DLM testing materials. There is no DPI DLM Confidentiality Form for Test Administrators/Proctors as they are required to sign an equivalent electronic form prior to accessing the portal.

• DLM SAC Confidentiality Agreement
• DLM DTC Confidentiality Agreement
• DLM STC Confidentiality Agreement

• DLM District/School Report User Confidentiality Agreement 

ACCESS Confidentiality forms – A confidentiality form must be completed by anyone who works with or views the ACCESS for ELLs testing materials.

• ACCESS SAC Confidentiality Agreement
• ACCESS DTC Confidentiality Agreement
• ACCESS STC Confidentiality Agreement
• ACCESS TA/Proctor Confidentiality Agreement
• ACCESS District/School Staff Confidentiality Agreement

Confirmation of Destruction Forms

Forward Exam 

Confirmation of Destruction Form for Print on Demand Accommodation Materials - This form must be complete when the district needs to destroy the Forward Exam Print on Demand materials.

Accommodations Forms

ACT

Requesting ACT Accommodations and Supports

DLM

DLM Assessment Request for Accommodation Form

Forward

Test Security Incident Report Form

Significant Medical Emergency Forms

Significant Medical Emergency Form (fill-enable)

Extended Testing Hours Forms