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* 1. Name and address of School?

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* 2. Name of person filling out this survey?

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* 3. Name of school Principal?

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* 4. Can we contact you for more information?

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* 5. Do you accept students with disabilities (please check all that apply)?

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* 6. If you answered “No” to question 5, would you be open to sharing your reasoning? (please check all that apply)?

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* 7. If you have students with disabilities, what are the specific identified needs you support?

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* 8. Do you have access to any specialized personnel to assist students with disabilities?

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* 9. How many students with disabilities have with a Non-public School Service Plan, Building Accommodation Plan, Modification Plan, or other special learning support plan?

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* 10. How many students with disabilities do you service at your school?

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* 11. What is the total number of students at your school?

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* 12. How long have you been addressing students with disabilities at your school?

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* 13. Have you been using the AOD’s documentation for modifications and accommodations for your students with disabilities?

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* 14. Are you interested in guidance or resources from the AOD to help with your programs (check all that apply)?

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* 15. What challenges do you face in providing support for students with disabilities?

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* 16. Do you use a Response to Intervention (RTI) approach with a three-tiered model?

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* 17. If you accommodate students with disabilities, how do you support them? (check all that apply)?

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* 18. What professional development opportunities have your teachers received related to meeting the needs of students with disabilities?

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* 19. How often do you review and update accommodation, modification and non-public school student service plans?

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* 20. How do you identify students who may need special education help (please check all that apply)?

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* 21. What interventions are available for struggling students before referring them for special education help?

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