Parent/guardian Refusal For Student Participation In Statewide Assessments printable pdf download

Minnesota Statutes, section 120B.31, subdivision 4a, requires the commissioner to create and publish a

form for parents and guardians to complete if they refuse to have their student participate in state-

required standardized assessments. Your student’s district may require additional information. School

districts must post this form on the district website and include it in district student handbooks.

Parent/Guardian Refusal for Student Participation in Statewide Assessments

To opt out of statewide assessments, the parent/guardian must complete this form and return it to the student’s school.

To best support school district planning, please submit this form to the student’s school no later than January 15 of the academic

school year. For students who enroll after a statewide testing window begins, please submit the form within two weeks of

enrollment. A new refusal form is required each year parents/guardians wish to opt the student out of statewide assessments.

Date

(This form is only applicable for the 20____ to 20____ school year.)

Student’s Legal First Name

Student’s Legal Middle Initial

Student’s Legal Last Name

Student’s Date of Birth

Student’s District/School

Grade

Please initial to indicate you have received and reviewed information about statewide testing.

I received information on statewide assessments and choose to opt my student out. MDE provides a

Parent/Guardian Guide to Statewide Testing on the

MDE website

(Students and Families > Statewide Testing).

Reason for refusal:

Please indicate the statewide assessment(s) you are opting the student out of this school year:

MCA/MTAS Reading

MCA/MTAS Science

MCA/MTAS Mathematics

ACCESS or Alternate ACCESS for ELLs

Contact your school or district for the form to opt out of local assessments.

I understand that by signing this form, my student will receive a score of “not proficient” and waives the opportunity

to receive a college-ready score that could save him/her time and money by not having to take remedial, non-credit

courses at a Minnesota State college or university. My school and I may lose valuable information about how well my

student is progressing academically. In addition, opting out may impact the school, district, and state’s efforts to

equitably distribute resources and support student learning.

Parent/Guardian Name (print)

Parent/Guardian Signature

To be completed by school or district staff only.

Student ID or MARSS Number

Parent/guardian Refusal For Student Participation In Statewide Assessments