This report discusses the many issues that need to be considered as states and districts begin to design and implement alternate assessments, which are used for students with severe cognitive delays or multiple disabilities or students who require such significant accommodations that the validity of the test would be compromised. The report provides examples from the two states, Maryland and Kentucky, that currently have such programs. The report begins by describing the differences between assessment, a process of collecting information, and accountability, a system activity designed to assure those inside and outside the educational system that schools are moving in desired directions. Thirteen issues to be considered in designing an alternate assessment program are then described and discussed, including: (1) eligibility for alternate assessments; (2) who makes eligibility decisions; (3) how to maintain a unified educational system; (4) how to avoid overuse of alternate assessments; (5) how to assess in reliable and valid ways; (6) whether data should be aggregated or reported separately; (7) how results should be communicated; (8) linkage between what is taught, what is tested, and giving students an opportunity to learn what is tested; (9) the costs and benefits; (10) how data will be collected: (11) types of data that should be collected; (12) confidentiality; and (13) how to ensure that school personnel are trained to administer, score, interpret, and use the results of alternate tests. (Author/CR)