Teacher Survey Form
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1Services for Students with Disabilities
Teacher Survey
Student Name: _________________________________ Return To: _________________________________
Teacher Name: _________________________________ Subject/Class: ____________________________
To the teacher: The student named above has requested testing accommodations for College Board tests. Your detailed
input regarding his/her needs on classroom tests is valuable in our decision making process.
1. How long has the student been in your class? __________________________________________
2. OBSERVATION: Briefly describe your observations of the student’s disability and its impact during your class.
Where possible, provide specific examples. Include the frequency and severity of symptoms displayed during class.
3. ACCOMMODATIONS USED: What specific accommodations are used by the student during classroom testing?
Please indicate which of these accommodations are used on a consistent basis.
4. EXTENDED TIME USED: If the student is provided extended time for classroom tests, how much additional time
does he/she generally use (e.g., 50%) to complete each of the following question types? (Note: Indicate time
actually used, not the time approved.)
a.
Multiple‐choice test items: _____________________
b. Other question types, such as short-answer questions, essays, and math problems (Indicate the amount of
additional time used for each applicable type):
c.
How does the student generally use the extended time (e.g., to complete test questions, to review
completed test questions, to take breaks, etc.)?
5. IMPACT: Describe the impact of the provided accommodations on the student’s performance. Does the student
use the accommodations effectively? How does it change his/her performance on tests? What happens if
accommodations are not provided?
Signature: ______________________________________________________________ Date: ________
Contact the College Board at 212-713-8333 if you have questions.
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