Reynolds School District *7 Administration Building 1204 N E 201" Avenue Fairvievv, O R 97024 503-661-7200 - FAX 503-667-6932

nolds School D i s t r i c t

Parent Request for Exemption from Summative Assessments-B Per OAR 581-022-1910, a student's parent or guardian may request that a student be excused from a state required program or learning activity, including state testing, to accommodate a student's disability or religious belief. The parent must submit the request in writing, listing the reasons for the request and proposing an alternative individualized learning activity for the student that meets the same goals that would be accomplished by participating in state testing. I request that be excused from state testing to accommodate his/her religious belief I have been provided an opportunity to discuss my child's sincerely held religious belief and I find that his/her religious belief still interferes with his/her ability to participate in state testing because (please summarize how the student's religious exemption is founded on a sincerely held religious belief, as opposed to a personal, political, or sociological belief without a religious basis):

I propose the alternative individualized learning activity for my child that meets the same goals that would be accomplished by participating in the state testing. (Attach additional pages, i f necessary).

Parent signature Date

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