REGENTS' TEST

TRANSMITTAL AND ADMINISTRATION REPORT FORM

Administrator's name __________________________________________________________________

Test date Time Location

1. RECEIPT OF MATERIALS

NUMBER OF TESTS RECEIVED: Essay ____________ Reading ____________

SERIAL NUMBERS OF READING TESTS RECEIVED: ______________________________

Verified: _________________________________________ ___ ______ _______ _____________

SIGNATURE of person receiving tests (if different from coordinator) DATE TIME

Verified: ____________________________________________ _____________ _____________

SIGNATURE of coordinator DATE TIME

Make sure that tests are in a secure location at all times.

2.A. DISTRIBUTION TO STUDENTS (ESSAY TEST)

Hand one essay test booklet directly to each examinee. Do not pass tests down aisles or rows.

Complete the following after the tests have been distributed (while students are taking the test):

NUMBER OF STUDENTS TAKING ESSAY TEST: ____________

Verified: _________________________________________ ___ ____ _________ _____________

SIGNATURE DATE TIME

Keep unused test booklets under supervision at all times.

2.B. TIMING (ESSAY TEST)

EXACT TIME ESSAY TEST BEGAN: ________ EXACT TIME ESSAY TEST ENDED: _______

(when students were told to begin) (when you said "time is up")

2.C. COLLECTION FROM STUDENTS (ESSAY TEST)

-If students are allowed to leave early, make sure that each student turns in a test booklet. Keep returned test booklets under supervision at all times.

-At end of administration, do not let students leave until all booklets are accounted for.

-Collect a test booklet directly from each student. Do not have students pass tests down aisles or rows.

NUMBER OF ESSAY TESTS COLLECTED: ____________

Verified: _________________________________________ ___ ____ _________ _____________

SIGNATURE DATE TIME

3.A. DISTRIBUTION TO STUDENTS (READING TEST)

Hand one test booklet directly to each examinee. Do not pass tests down aisles or rows.

Complete the following after tests have been distributed (while students are taking the test):

NUMBER OF STUDENTS TAKING READING TEST: ____________

NUMBER AND SERIAL NUMBERS OF READING BOOKLETS:

DISTRIBUTED:___________________________________________________________

UNUSED:________________________________________________________________

Make sure that the number of tests distributed and the number unused add up to the total number of tests you received.

Verified: _________________________________________ ___ ____ _________ _____________

SIGNATURE DATE TIME

Keep unused test booklets under supervision at all times.

3.B. TIMING (READING TEST)

EXACT TIME READING TEST BEGAN: ________ EXACT TIME TEST ENDED: _______

(when students were told to begin) (when you said "time is up")

3.C. COLLECTION FROM STUDENTS (READING TEST)

-If students are allowed to leave early, make sure that each student turns in a test booklet. Keep returned test booklets

under supervision at all times.

-At end of administration, do not let students leave until all booklets are accounted for.

-Collect a test booklet directly from each student. Do not have students pass tests down aisles or rows.

NUMBER OF READING TESTS COLLECTED: ____________

Verified: ____________________________________________ _____________ _____________

SIGNATURE DATE TIME

4. RETURN OF MATERIALS

NUMBER OF TESTS RETURNED: Essay ____________ Reading ____________

SERIAL NUMBERS OF READING TESTS RETURNED: __________________________

Checked and Verified (by person responsible for receiving tests):

__________________________________________________ _____________ _____________

SIGNATURE DATE TIME

5. PROBLEMS

Please attach a description of any irregularity or problem with the test administration that may have

affected either individual examinees or a group of examinees. Describe the irregularity in detail and indicate the test booklet number(s) and name(s) of any examinee that may have been affected by the irregularity.