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The survey covers timing, organization, persistence, and social-emotional behaviors using a 1–5 scale (almost never to consistently) alongside optional narrative comments. It also prompts educators to describe observed effects, list formal or informal accommodations and implementation duration, and provide school-use information plus teacher certification and signature.",{"@graph":69,"@context":122},[70,84,105],{"@type":71,"itemListElement":72},"BreadcrumbList",[73,77,79,82],{"item":74,"name":75,"@type":76,"position":8},"https://docshare.wps.com","Home","ListItem",{"item":78,"name":9,"@type":76,"position":14},"https://docshare.wps.com/document/",{"item":80,"name":20,"@type":76,"position":81},"https://docshare.wps.com/document/exam/",3,{"item":83,"name":65,"@type":76,"position":19},"https://docshare.wps.com/document/teacher-survey-form-accommodations-and-el-supports/530111/",{"url":83,"name":65,"@type":85,"image":86,"author":91,"headline":65,"publisher":94,"fileFormat":97,"inLanguage":63,"description":67,"dateModified":98,"datePublished":99,"encodingFormat":97,"isAccessibleForFree":100,"interactionStatistic":101},"DigitalDocument",{"url":87,"@type":88,"width":89,"height":90},"https://docshare.wps.com/thumbnails/teacher-survey-form-accommodations-and-el-supports/530111.png","ImageObject",300,407,{"name":92,"@type":93},"pixelkiddo","Person",{"url":74,"name":95,"@type":96},"DocShare","Organization","application/pdf","2026-11-11","2026-10-09",true,{"@type":102,"interactionType":103,"userInteractionCount":29},"InteractionCounter",{"@type":104},"ViewAction",{"@type":106,"mainEntity":107},"FAQPage",[108,114,118],{"name":109,"@type":110,"acceptedAnswer":111},"What rating scale does the teacher survey use?","Question",{"text":112,"@type":113},"For each statement, rate from 1–5, where 1 means almost never, 3 means typical, and 5 means consistently. 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This form is to help ACT understand the impact of the student’s diagnosis in the educational environment.  \nInstructions  \nFor each item below, please rate on a scale of 1–5 (1 = almost never, 3 = typical, 5 = consistently) how the statement describes your student when compared to peers. Any additional comments are welcomed to give further context.  \n\n| Student’s Name |\n| --- |\n| Teacher’s Name |\n\nFOR SCHOOL USE  \nReturn-by Date (MM/DD/YYYY)  \nTiming Statements  \n1. Requires individual prompting to get started  \n2. Fails to complete work on time  \n3. Requires additional time on tests/assignments  \nalmost never 1 2  \n1 2  \n1 2  \ntypical 3  \n3  \n3  \n4  \n4  \n4  \nconsistently 5  \n5  \n5  \nNote: If additional time is needed, how much and why is it needed?  \nComments  \nOrganization Statements  \nalmost never  \n1. Fails to bring appropriate materials 1 2  \n2. Has difficulty locating notes, homework, other papers 1 2  \ntypical 3  \n3  \n4  \n4  \nconsistently 5  \n5  \nComments  \n© 2026 by ACT Education Corp. All rights reserved. Page 1 of 2 SV09001 .CJ23457  \nPersistence Statements  \nalmost never  \n1. Is distracted by other students or objects in class 1 2  \n2. Requires redirection to complete work during class 1 2  \n3. Has difficulty following verbal and/or written directions 1 2  \n4. Has difficulty self-evaluating work 1 2  \ntypical 3  \n3  \n3  \n3  \n4  \n4  \n4  \n4  \nconsistently 5  \n5  \n5  \n5  \nComments  \nSocial/Emotional Statements  \n1. Struggles to regulate emotions  \n2. Interrupts others  \n3. Acts impulsively—verbally or physically  \n4. Is unable to give presentations to the class  \n5. Has difficulty participating in group work  \n6. Avoids verbally responding to questions  \nalmost never  \n1  \n1  \n1  \n1  \n1  \n1  \n2  \n2  \n2  \n2  \n2  \n2  \ntypical 3  \n3  \n3  \n3  \n3  \n3  \n4  \n4  \n4  \n4  \n4  \n4  \nconsistently 5  \n5  \n5  \n5  \n5  \n5  \nComments  \nClassroom Strategies and Supports  \nWhat impact have you observed related to the student’s diagnosis?  \nPlease list any formal or informal accommodations you have provided, and indicate how long each has been in place:  \nCertification  \nTeacher’s Signature  \nDate (MM/DD/YYYY)  \n© 2026 by ACT Education Corp. All rights reserved. Page 2 of 2 SV09001 .CJ23457","cbCaim9zeqDrOUF3","https://ap.wps.com/l/cbCaim9zeqDrOUF3","pdf",194850,"English","# Timing Statements\n# Organization Statements\n# Persistence Statements\n# Social/Emotional Statements\n# Classroom Strategies and Supports","[{\"question\":\"What rating scale does the teacher survey use?\",\"answer\":\"For each statement, rate from 1–5, where 1 means almost never, 3 means typical, and 5 means consistently. Ratings compare the student to peers.\"},{\"question\":\"What sections does the form include besides ratings?\",\"answer\":\"In addition to timing, organization, persistence, and social/emotional statements, the form includes prompts for comments and for classroom strategies and supports, including accommodations and their duration.\"},{\"question\":\"What information is required for school use at the end of the form?\",\"answer\":\"The form requests a return-by date (MM/DD/YYYY) and includes certification details such as the teacher’s signature and a date (MM/DD/YYYY).\"}]","Teacher Survey Form - Accommodations and EL Supports | PDF",1791522596]