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* 1. Indicate if you are a:

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* 2. Do you teach:

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* 3. To what extent does the decision to include a student with an IEP in a general education classroom depend upon the student's disability category?

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* 4. To what extent does the decision to include a student with an IEP in a general education classroom depend upon the perceived functioning level of the student?

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* 5. To what extent does the decision to include a student with an IEP in a general education classroom depend upon the student's ability to be successful without additional supports?

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* 6. To what extent is there common planning time available within the typical school week for general education teachers and special education teachers to meet and jointly plan/problem-solve issues about curriculum and instruction?

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* 7. To what extent do you know what is involved with each of the following educational practices?

  Very little or none Somewhat Extensive
Modified Curriculum
Multi-Level Curriculum
Over-Lapping Curriculum
Peer Support
Cooperative Learning
Peer Mediated Instruction
Differentiated Instruction
Team Teaching and/or Co-Teacher
Positive Behavior Intervention (Classroom Level)
Positive Behavior Support (Individualized for a Student)
Augmentative Communication
Assistive Technology

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* 8. To what extent do you know how to implement each of the following educational practices?

  Very little or none Somewhat Extensive
Modified Curriculum
Multi-Level Curriculum
Over-Lapping Curriculum
Peer Support
Cooperative Learning
Peer Mediated Instruction
Differentiated Instruction
Team Teaching and/or Co-Teaching
Positive Behavior Intervention (Classroom Level)
Positive Behavior Support  (Individualized for a Student)
Augmentative Communication
Assistive Technology

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* 9. To what extent have you implemented each of the following educational practices to support students with an IEP within a general education classroom ("NA" indicates Not Applicable):

  Very little or none Somewhat Extensive NA
Modified Curriculum
Multi-Level Curriculum
Over-Lapping Curriculum
Peer Support
Cooperative Learning
Peer Mediated Instruction
Differentiated Instruction
Teach Teaching or Co-Teaching
Positive Behavior Intervention (Classroom Level)
Positive Behavior Support (Individualized for a Student)
Augmentative Communication
Assistive Technology

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* 10. To what extent do you feel your students would benefit from your receiving information, training and/or technical assistance with respect to each of the following education practices:

  Very Little Somewhat Extensive
Modified Curriculum
Multi-Level Curriculum
Over-Lapping Curriculum
Peer Support
Cooperative Learning
Peer Mediated Instruction
Differentiated Instruction
Teach Teacher and/or Co-Teaching
Positive Behavior Intervention (Classroom Level)
Positive Behavior Support (Individualized for a Student)
Augmentative Communication
Assistive Technology

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* 11. To what extent do you feel you need training in the following approaches?

  Very little or none Somewhat Extensive
Modified Curriculum 
Multi-Level Curriculum
Over-Lapping Curriculum
Peer Support
Cooperative Learning
Peer Mediated Instruction
Differentiated Instruction
Teach Teaching and/or Co-Teaching
Positive Behavior Intervention (Classroom Level)
Positive Behavior Support (Individualized for a Student)
Augmentative Communication
Assistive Technology

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* 12. Are there barriers to successfully including students with IEPs within your school's general education classrooms?

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* 13. If the answer to the above question (#12) is yes, what are the top three factors contributing to barriers?

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* 14. What resources and/or supports would help general education teachers increase inclusion of students with an IEP? (Please list or briefly describe)

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