Teacher Questionnaire for Deaf and Hard of Hearing Students Survey

Question Title

* 1. Please list the following:

Your name:

Subject:

Student's name:

Site Location:

Date:

Question Title

* 2. Does your classroom have:

	Yes	No	Sometimes	Maybe	I Don't Know	Other
Ceiling acoustic tiles?	Ceiling acoustic tiles? Yes	Ceiling acoustic tiles? No	Ceiling acoustic tiles? Sometimes	Ceiling acoustic tiles? Maybe	Ceiling acoustic tiles? I Don't Know	Ceiling acoustic tiles? Other
Carpet?	Carpet? Yes	Carpet? No	Carpet? Sometimes	Carpet? Maybe	Carpet? I Don't Know	Carpet? Other
Background noise present?	Background noise present? Yes	Background noise present? No	Background noise present? Sometimes	Background noise present? Maybe	Background noise present? I Don't Know	Background noise present? Other

Other (please explain)

Question Title

* 3. Is the student strategically seated to the instruction (preferential seating)?

Yes

Sometimes

Maybe

I Don't Know

Other (please specify)

Question Title

* 4. In regards to lighting:

	Yes	No	Sometimes	Maybe	I Don't Know	Other
Is there a glare?	Is there a glare? Yes	Is there a glare? No	Is there a glare? Sometimes	Is there a glare? Maybe	Is there a glare? I Don't Know	Is there a glare? Other
Is the student seated near windows?	Is the student seated near windows? Yes	Is the student seated near windows? No	Is the student seated near windows? Sometimes	Is the student seated near windows? Maybe	Is the student seated near windows? I Don't Know	Is the student seated near windows? Other
Is the lighting appropriate?	Is the lighting appropriate? Yes	Is the lighting appropriate? No	Is the lighting appropriate? Sometimes	Is the lighting appropriate? Maybe	Is the lighting appropriate? I Don't Know	Is the lighting appropriate? Other

Other (please explain)

Question Title

* 5. How do you provide visual aids in your classroom? (i.e. Use of ELMO, Smartboard, Schedule posted, Homework posted)

Question Title

* 6. What accommodations are used within the classroom? (Check all that apply)

Student uses Hearing Assistive Technology such as hearing aids, FM system, or a sound field

Student uses closed captioning during video presentations

Student has preferential seating

Other (please specify)

Question Title

* 7. Student uses the following hearing assistive technology in the classroom (Check all that apply)

Hearing aids

FM system

No hearing assistive technology is used in my classroom

Other (please specify)

Question Title

* 8. (Check all that apply) The student

ask questions.

comes to class prepared.

raises his/her hand to ask a question.

asks for help appropriately.

works well with others.

asks for clarification.

asks for repetition of missed information.

uses visual strategies.

watches the teacher's face while listening to instruction.

Other (please specify)

Question Title

* 9. (Check all that apply) The student is

near a pencil sharpener.

near a door.

near AC/Heater vent.

seated with better ear towards the teacher.

seated near the instructor.

Other (please specify)

Teacher Questionnaire for Deaf and Hard of Hearing Students

Questionniare for Teachers with Students who are Deaf or Hard of Hearing

Question Title

* 1. Please list the following:

Question Title

* 2. Does your classroom have:

Question Title

* 3. Is the student strategically seated to the instruction (preferential seating)?

Question Title

* 4. In regards to lighting:

Question Title

* 5. How do you provide visual aids in your classroom? (i.e. Use of ELMO, Smartboard, Schedule posted, Homework posted)

Question Title

* 6. What accommodations are used within the classroom? (Check all that apply)

Question Title

* 7. Student uses the following hearing assistive technology in the classroom (Check all that apply)

Question Title

* 8. (Check all that apply) The student

Question Title

* 9. (Check all that apply) The student is

Question Title

* 10. Please add any information that would be of benefit for the IEP team.