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0%
 
 
1. Gender:
 
Male
 
Female
 
 
 
2. Ethinic Information
 
African-American
 
Native American
 
Asian/Pacific Islander
 
Spanish/Hispanic
 
Caucasian
 
Other
 
 
 
3. What is your age?
   
 
 

Standard Provisional Pending No license
What is your current teaching licesure status?
 
 
 
In what area is your license?
   
 
 
6. 
Less than one year 1-2 years 2-4 years over five years
How many years of teaching experience do you have? (Do not include student teaching)
 
 
7. 
Less than one year 1-2 years 2-4 years over 5 years
How many years do you have teaching students with High Incidence Disabilities?
 
 
8. 
Very knowledgeable knowledgeable somewhat knowlegdeable not at all knowledgeable
Indicate your level of knowledge of the psycholigical, social, and academic characteristics of students with High Incidene Disabilities:
 
 
9. 
Very knowledgeable Knowledgeable somewhat knowledgeable not at all knowledgeable
Indicate your level of knowledge of research based practices for educating students with High Incidence Disabilities:
 
 
10. 
Very knowledgeable Knowledgeable somewhat knowledgeable not at all knowledgeable
Indicate your level of knowledge of specialized materials, curricula and resources for students with High Incidence Disabilities:
 
 
11. 
Very knowledgeable knowledgeable somewhat knowledgeable not at all knowledgeable
Indicate your level of knowledge of sound behavior management assessments and techniques:
 
 
12. 
Very Knowledgeable knowledgeable somewhat knowledgeable no at all knowledgeable
Indicate your level of knowledge of models and strategies of consultation and collaboration:
 
 
13. 
extensive experience experience very little experience none
Indicate your level of proficiency in designing and implementing instructional and assistive technology:
 
 
14. 
Very interested somewhat interested not very interested not interested at all
Are you interested in obtaining certification in Special Education:
 
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