Survey of Accommodations for Students with Disabilities in Academic Settings

The purpose of this study is to create a central database which collects and shares information about accommodations and adaptations used with students with disabilities in academic settings.

Participants are asked to complete a survey, where they can share accommodations and adaptations which they have used themselves as someone with a disability or as an educator working with a student with a disability. The shared accommodations will then be posted on a central website for all to view and gain ideas about how to better support different disabilities in the educational setting.

There are no inherent risks for you to participate in this research study. To make your participation safer, we do not require you to sign this consent form. By not signing the consent, form your name will not be connected with your questionnaire responses in any way. You will give your consent for being a subject in this research project through completing the attached survey. Please also realize that the open-ended questions need only be completed if you feel safe completing them. You may disclose your name if you feel safe doing so at the end of the survey.

Although there are no explicit or guaranteed benefits for your participation in the study, we anticipate that participants and others involved in education would learn new ways to support students with disabilities at different academic levels and with various disabilities.

Privacy and Confidentiality:
Your name will not be connected to this survey in any way unless you choose to write it on the bottom of the survey. Your name, if given, still will not be connected to your responses on the survey.

The records of your responses to the questionnaire will be kept confidential on a secure server, when not being reviewed by the researcher. The original surveys will be destroyed on a quarterly (every three months) basis.

Voluntary Participation/Withdrawal:
Taking part in this study is completely voluntary. Taking part, or not, in this study will not affect you. You are free to answer as many or as few questions as you feel comfortable on the survey. You may stop your participation in filling out the survey at any time, and are not required to turn in the survey, if you do not feel comfortable about its content.

Questions or Concerns:
If you have questions about your rights as a research subject, you may contact: Director, Office of Research Compliance, University of Southern Maine at (207) 780-4268 or TTY (207) 780-5646 or by email at

Please be advised that Julie R. Alexandrin, Ph.D. can answer any other questions you may have concerning this research. You may call Julie at (207) 228-8320 or email her at

Statement of Consent:
I have read (or have had read to me) the contents of this consent form and have been encouraged to ask questions. I have received answers to my questions. I give my consent to take part in this study through my full or partial completion of the attached survey. I affirm that I have not been coerced or forced to participate in this study. My participation is completely voluntary. I understand that the information gathered will be anonymous.

Please Complete All Questions.

1.What is your age?
2.What is your gender?
4.What is the highest level of education you have participated in?
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