1. education
2. english as a second language

Guidance on Completing the DeSSA Human Interpreter Forms
for Smarter Assessments
The notes in the margins of this document provide guidance and clarification regarding the completion
of the questions on the Human Interpreter Verification form and the Human Interpreter Certification
Requirements form.
Human Interpreter Verification Form Guidance ………………………………………………………………………..Page 3-4
Human Interpreter Certification Requirements Form Guidance ………………………………………………..Page 5-6
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Smarter Mathematics – Human Interpreter Verification Form
(Student Form)
The Human Interpreter Designated Support is related to students with hearing impairments and
English language learners. Use of the Human Interpreter Designated Support will not invalidate
the test if used according to the guidelines provided by Delaware Department of Education and
Smarter Balanced.
Date:____________
Student Name: Last ______________________ First________________________
DELSIS ID #________________Birthdate_________________________________
District___________________________School_____________________________
Grade_________ School Contact’s email __________________________________
School Contact’s name __________________________________
1. Are human or electronic interpretation and/or translated materials provided to the student
for instruction and/or assessment?  Yes  No
3. Indicate below the area(s) in the IEP where human interpreter for the identified
communication method is a documented instructional support.
 In the Data Considerations (including “Other Factors”)
 In the Statement of Services (top of Goal Pages)
 As a Condition to the Student’s Goal(s)
 Other:______________________________________
Primary Language: the language a person has
learned from birth. See also: Native language, or L1.
Secondary Language: any language that one speaks
other than one’s first language.
Dominant Language: the language in which the
student is most proficient, overall. NOTE: the dominant
language is not always the student’s Primary or Native
language.
Non-Dominant Language: any language spoken by
the student that is not the student’s dominant language
Literacy PL: an ACCESS performance level (PL) score
created by combining the student’s ACCESS reading
PL and the student’s ACCESS writing PL.
Literacy: refers to the student’s level of reading and
writing proficiency in a particular language.
Commented [DH2]: Question #1 should be completed
for all students including students with disabilities
(SWD’s) and ELLs.
 No
Date of Eligibility Determination: __________________________________
5. What is the student’s proficiency level in English? Include WIDA ACCESS test scores
below:
________________________________________________________________________
Note: ELLs with an ACCESS Composite PL of 3.5 or lower and a Literacy PL of 3.0 or lower may qualify for
human interpreter.
Please continue on Page 2.
For ELL students, the form should be completed by
an ESL teacher, then reviewed & submitted to DOE by
a district ESL Coordinator OR the form may be
completed and submitted by the District ESL
coordinator.
For SWD/ELL students, the district ESL Coordinator
will work in tandem with the Special Education
department to complete the required ELL student data.
For SWD students, the form should be completed by a
special education teacher, then reviewed & submitted
to DOE by a school or district special education
coordinator OR the form may be completed and
submitted by the school or district special education
coordinator.
The following are definitions assumed for the
purposes of this form:
Accommodation 6.10 – for Math and ELA Listening Items
Complete the section below for a Student with a Hearing Impairment:
2. Does the student communicate using American Sign Language (ASL)?
 Yes
 No
If no, indicate the method used for communication.
 Signed English
 Cued Speech
 Other Visual Support: _________________________________
Designated Support 4.12 for Math Items
Complete the section below for an English Language Learner:
4. Is the student within the first 3 years of ELL eligibility?
 Yes
Commented [DH1]:
Who should complete this form?
Commented [DH3]: Complete questions 2 and 3 for
accommodation 6.10 only for students with disabilities
or dually identified ELLs with disabilities that use visual
communication.
Students who communicate using ASL should use the
embedded ASL accommodation if needed for ELA
Listening and Math items (accommodation 5.01).
Closed Captioning is also available for ELA listening
items (accommodation 5.03).
Commented [DH4]: Complete questions 4-8 for
accommodation 4.12 only for ELLs or SWDs who are
also ELLs.
Form should be signed on page 2 for both SWDs
and ELLs.
Human Interpreter Verification Form (Student Form)
Page 1 of 2
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Smarter Mathematics – Human Interpreter Verification Form
(Student Form)
6. Student Languages – indicate with an * which language, a or b, is the student’s dominant
language.)
a. What is the student’s primary language? __________________________________
b. What is the student’s secondary language? ________________________________
c. In which language will the student receive interpretation? _____________________
7. Is the student literate in the language in which they will receive interpretation?
 Yes
 No
Note: If the ELL is not literate in Spanish (full translation) or in a language provided by Smarter glossaries, or
the student’s primary language is not provided by Smarter glossaries, the ELL may qualify for the Human
Interpreter Designated Support.
8. Indicate below how the native or primary language is used for instructional purposes.
 Interpretation support
 Written translation
 Electronic resources
 Other: ______________________________________
Signature/Title__________________________________
 Print resources
Date:______________
Name (print) _____________________________________
Note: This documentation is to be kept in the student’s file. This form must be scanned and
emailed to Helen.dennis@doe.k12.de.us . DOE will respond within ten business days. Students may
not be administered this Designated Support without written approval from DOE.
Commented [DH5]: The purpose of this question is to
identify ELL students that speak more than one
language in addition to English.
An ELL student whose dominant language is not
supported by smarter but who speaks another
language that is supported by smarter may be able to
take the test with supports provided in the nondominant language, if the student reads and writes well
(is literate) in the non-dominant language.
Commented [DH6]:
In this question, the word “literacy” refers to a ELL
student’s reading and writing level in the native
language. It does not refer to the student’s listening or
speaking ability.
The purpose of this question is to identify ELL students
who are, on the literacy spectrum, closer to FULLY
literate in the native language.
ELL students who read and write well in their native
language—who are more fully literate-- and whose
native language is supported by smarter with a full
translation or a translated glossary, should be able to
use the full translation (support 3.06- Spanish/English
stacked full translation online test) or the translated
glossary-embedded (3.05) or non embedded (4.08)
and should NOT require a human interpreter.
A full translation is provided for Spanish in the
Spanish/English stacked (3.06).
Embedded translated glossaries (support 3.05) are
provided in the following languages: Arabic, Tagalog ,
Ilokano, Cantonese, Mandarin, Korean, Punjabi,
Russian, Ukrainian, Vietnamese, and Spanish.
Non embedded translated glossaries (support 4.08) are
provided for the paper/pencil test in the following
languages: Arabic, Tagalog, Ilokano, Cantonese,
Mandarin, Korean, Punjabi, Russian, Ukrainian,
Vietnamese. (NOTE: Spanish not available).
Human Interpreter Verification Form (Student Form)
Page 2 of 2
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Smarter Mathematics- Human Interpreter Certification Requirements
In o rder fo r a n inte rpreter to pro vide the Human Interpre ter De signated Support o n the
Sma rter Ma thematics a ssessments, the Lo cal Education Agency must a ssure tha t the
inte rpre ter me ets the re quirements below. Fill o ut the fo rm a t submit to DOE co ntact liste d.
Use o f the Human Interpre ter De signated Support will no t inva lidate the te st if used a ccording
to the guidelines pro vided by De la ware Department o f Educa tion a nd Smarte r Ba lanced. A
Human Interpreter must be supervised a t a ll time s by a qualified te acher o r pa raprofessional
who ha s co mpleted the re quirements fo r a dministering the Smarter Ba la nce Assessment.
Da te :___________________
Commented [DH1]: DOE is not screening these
“Requirements” forms, only collecting them for
verification after interpretation has taken place.
LEA: ________________________________________
Inte rpre ter’s Na me: La st ______________________ First ______________________
Scho ol(s) whe re interpretation will be pro vided: _______________________________
Scho ol Contact’s e mail ___________________________________________________
Scho ol Contact Na me (type o r print) ________________________________________
Inte rpre ter fo r Signed English, Cued Speech o r Othe r Visual Support (Acco mmodation 6.10)
1. P ro ficiency in Signed English, Cued Speech o r Other Visual Support re quire d by the
student
To demonstra te pro ficiency the inte rpreter must have:
 Ce rtifica tion fro m a P ro fessional Organization; OR
 Curre nt o r pre vious e mployment in a po sition re quiring inte rpretation
2. Kno wledge o f K-12 Education
3. Kno wledge o f Co ntent Vo cabulary
4. Ba ckgro und in Visual Supports (e .g., signed English, cue d speech)
Commented [DH2]: Complete this section for
interpreters serving students with disabilities or dually
identified ELLs with disabilities.
Flue nt in the fo llowing Visual Supports:__________________________________
Inte rpre ter fo r Wo rld La nguages (Designated Support 4.12)
1. P ro ficiency in Wo rld La nguage a nd English
To demonstra te pro ficiency the inte rpreter must have:
 Ce rtifica tion fro m a P ro fessional Organization; OR
 Curre nt o r pre vio us e mployment in a po sition re quiring interpretation; OR
 Na tive o r near na tive fluency in the wo rld la nguage a nd English
2. Kno wledge o f K-12 Education
3. Kno wledge o f Co ntent Vo cabulary
Commented [DH3]: Complete this section for
interpreters serving ELLs or students with disabilities
who are also ELLs.
Flue nt in the fo llowing World La nguages:__________________________________
If the inte rpreter ha s documented a ssessment sco res re lated to Wo rld La nguage a nd/or
English pro ficiency, please list be low. (Information o nly)
Na me o f Test
Year o f Te st
P lease a lso co mplete the information o n P age 2.
DeSSA Human Interpreter Certification Requirements, Page 1 of 2
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Commented [DH4]: In this section, the purpose is to
obtain available test scores received by the interpreter
on tests such as ACTFL, TOEFL, PRAXIS, or tests of
proficiency in a world language.
These scores are requested for Information ONLY.
No interpreter will be rejected on the basis of these
scores during the 2014-15 test window.
Additional Requirements fo r All Human Interpreters:
 Fa miliarity with the Site Tra nslator pro to col in the Acce ssibility Guidelines
 Co mpletion o f De SSA Test Se curity tra ining (a n o nline co urse a cce ssed via P DMS)
 Ba sic co mputer lite ra cy
By signing below, the LEA a ssure s tha t the interpreter a bove ha s met the re quirements a bove.
Signature/Title__________________________________
Da te :______________
Commented [DH5]: The DeSSA Support certification
training module PDMS #23777 includes security
training and a certification form. This module is
required for those providing interpretation if they are
not already certified test administrators. The module
is available online for individuals with access to PDMS
and also on a CD by request to
lisa.alexander@doe.k12.de.us .
Na me (print) _____________________________________
N ote: T his documentation is to be kept at the LEA. T his form must be scanned and emailed to
H elen.dennis@doe.k12.de.us before the c onclusion of the assessment window along with the E xcel file listing
all s tudents who received Human Interpreter D esignated Support.
DeSSA Human Interpreter Certification Requirements, Page 2 of 2
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Commented [DH6]: Please send this form to DOE,
accompanied by a list of students for whom the
individual provided interpretation, after the
interpretation has taken place for all students.