Title: SECTION <D - SERVICE-PROVD>ER INFORMAllON
Author: Chris Gaulin
Company: Gestion Comptable AMG Inc.

Working Towards a Coordinated National Approach to Services  -  Service Provider Survey

SECTION 1 – Service Provider Information 

The following questions are designed to provide us with information on your educational institution. Please fill in the blanks and check the appropriate responses for each question. 

1. 	In what province/territory is your educational institution? 
______________________________________________

2. 	What is tie name of your educational institution? 
______________________________________________

3. 	Type of educational institution? 
1 ☐ University 
2 ☐ Community College 
3 ☐ CEGEP
4 ☐ Other, please specify _______________________

4. 	What types of qualification does your institution offer? (please check all that apply) 
1 ☐ Certificate or diploma 
2 ☐ Bachelor's degree 
3 ☐ Master's degree 
4 ☐ Doctorate 
5 ☐ Other, please specify _______________________

5. 	Total number of students enrolled at your institution, as of September 1997? (approximate) 
Full-time _______
Part-time _______

6. 	Number of students with disabilities that you serve at your institution as of September 1997? (approximate) 
Full-time _______
Part-time _______

7 	Does your institution provide ANY special facilities, equipment, policies or services for students with disabilities? 
1 ☐ Yes 	2 ☐ No 	If no, go to question 9. 

8. 	If YES, does your institution have a separate unit(s) (e.g. office or centre) that ONLY provides special facilities, equipment or services for students with disabilities? 
1 ☐ Yes 	2 ☐ No 	If yes, go to question 10. 

9. 	If NO, does your institution have a separate unit (e.g. office, centre) that provides special facilities, equipment or services for students with disabilities AS WELL AS for other students? 
1 ☐ Yes 	2 ☐ No 	If no, go to question 18 (page 5). 

10. 	If YES, please give the tide of this unit and briefly describe its mandates (e.g. services offered, types of students served, etc.). If more than one exists, please list and describe the THREE LARGEST (by staff) units:  (if necessary, please use reverse side)
___________________________________________________________
___________________________________________________________
	___________________________________________________________
___________________________________________________________

11. 	Does the unit receive its own operating budget from the university?
First Unit	1 ☐ Yes	2 ☐No
Second Unit	1 ☐ Yes	2 ☐No
Third Unit	1 ☐ Yes	2 ☐No

11a. 	If NO, where does it receive its budget from?
First Unit: __________________________________
Second Unit: ________________________________
Third Unit: __________________________________

11b. 	Are there any services which you offer (e.g. sign language/oral interpretation) that are funded by an outside source? (e.g. government)
1 ☐ Yes	2 ☐ No		If no, go to question 12.

11c. 	If yes, please list these outside sources.
___________________________________________________________
___________________________________________________________
	___________________________________________________________

12. 	How many paid employees work in this unit? 
First Unit: 	___ Full-time 		___ Regular Part-time 
___ Casual Part-Time 	___ Casual (e.g. hourly tutors) 
Second Unit: 	___ Full-time 		___ Regular Part-time 
___ Casual Part-Time 	___ Casual (e.g. hourly tutors) 
Third Unit: 	___ Full-time 		___ Regular Part-time 
___ Casual Part-Time 	___ Casual (e.g. hourly tutors) 

13. 	Does this unit coordinate the work of volunteers? 
First Unit	1 ☐ Yes	2 ☐No
Second Unit	1 ☐ Yes	2 ☐No
Third Unit	1 ☐ Yes	2 ☐No

14. 	If YES, how many volunteers work under the direction of this unit? 
First Unit: ____ 	Second Unit: ____ 	Third Unit: ____

15. 	What is the average number of hours of work done by volunteers in the typical, regular-term week (approximate)? 
First Unit: ____ 	Second Unit: ____ 	Third Unit: ____

16. 	In general, are there any particular programs or services for which the assistance of volunteers is sought? 
1 ☐ Yes 	2 ☐ No 

16a. 	If yes, please list these programs/services: 
___________________________________________________________
___________________________________________________________
	___________________________________________________________

17. 	Does your institution share any facilities, equipment or services for students with disabilities with other post-secondary educational institutions? 
1 ☐ Yes 	2 ☐ No 

17a. 	If yes, please describe (e.g. shared bus services, oral interpretation services, etc.): 
___________________________________________________________
___________________________________________________________
	___________________________________________________________

18. 	Which of the following types of disabilities can be accommodated by your institution? 
1 ☐ Blind/Visually impaired 
2 ☐ Deaf/Hard of hearing 
3 ☐ Mobility impaired 
4 ☐ Speech impaired 
5 ☐ Learning disability 
6 ☐ Medical disability 
7 ☐ Mental health disability 
8 ☐ Other, please specify: 

19. 	Are some students who request services required to provide documentation related to their disability? 
1 ☐ Yes 	2 ☐ No 		If no, go to question 20 (page 6). 

19a 	If yes, in what cases is this required and what kinds of documentation are requested? 
___________________________________________________________
___________________________________________________________
	___________________________________________________________

20. 	In general, does access to the facilities, equipment or services for students with disabilities decrease in the summer months? 
1 ☐ Yes 	2 ☐ No 		If no, go to question 21. 

20a. 	If yes, describe the decrease, or what facilities, equipment or services are affected: 
___________________________________________________________
___________________________________________________________
	___________________________________________________________

20b. 	In general, does access to the facilities, equipment or services for students with disabilities decrease in the evenings and on weekends? 
1 ☐ Yes 	2 ☐ No 		If no, go to question 11. 

20c 	If yes, describe the decrease, or what facilities, equipment or services are affected: 
___________________________________________________________
___________________________________________________________
	___________________________________________________________

21. 	Does your institution have an independent group organized by and (or students with disabilities? 
1 ☐ Yes 	2 ☐ No 		If no, go to question 11 (page 7). 

21a. 	If yes, provide the name of this organization: 
	___________________________________________________________
Contact Person:  _____________________________________________
Phone No. (please include area code): ____________________________
e-mail address: ______________________________________________

22. 	Does your institution have a committee dealing with issues of accessibility? 
1 ☐ Yes 	2 ☐ No 		If no, go to question 24. 

22a. 	If yes, does this committee have representation from students with disabilities? 
1 ☐ Yes 	2 ☐ No 

23. 	If yes, can you provide us with the name of the chair or head of this committee and a contact number'! 
__________________________________________________________
__________________________________________________________
Phone No(s). (please include area code): _________________________
e-mail address: ______________________________________________

24. 	Does the main students' organization at your institution have any positions that focus on issues related to students with disabilities? 
1 ☐ Yes 	2 ☐ No	 	3 ☐ Don't know 

24a. 	If yes, can you provide us with the name(s) and contact information for any student(s) who currently occupy these positions? 
__________________________________________________________
Phone No(s). (please include area code): _________________________
e-mail address: ______________________________________________

25. 	Overall, how would you describe the model of service delivery for students with disabilities at your educational institution? 
1 ☐ Centralized - all special services through same unit 
2 ☐ Partially Centralized - most special services through same unit, some through other offices 
3 ☐ Decentralized - special services offered through various offices, no central unit 
4 ☐ Other, please describe ___________________________________
		___________________________________________________
		___________________________________________________

26. 	Are you aware of any modifications or additions to current programs that are in the planning stages as of January 1st, 1998 which would improve educational accessibility? 
1 ☐ Yes 	2 ☐ No 

If yes, please indicate what they are: 
___________________________________________________________
___________________________________________________________
	___________________________________________________________

27 	Are you aware of any modifications or additions to policy or to current administrative practice which would improve accessibility, that are in planning as of January 1st, 1998? 
1 ☐ Yes 	2 ☐ No 

If yes, please indicate what they are: 
___________________________________________________________
___________________________________________________________
	___________________________________________________________

27a. 	Are you aware of any building modifications or additions, which would improve physical accessibility, that are in planning as of January 1st, 1998? 
1 ☐ Yes 	2 ☐ No 

If yes, please indicate what they are: 
___________________________________________________________
___________________________________________________________
	___________________________________________________________

28. 	How are students with disabilities made aware of services and accommodations that are available to them? 
___________________________________________________________
___________________________________________________________
	___________________________________________________________
___________________________________________________________
___________________________________________________________
	___________________________________________________________

28a. 	Do you have written materials about services and accommodations that are made available to students with disabilities? 
1 ☐ Yes 	2 ☐ No 

28b. 	If yes, please list by title: 
___________________________________________________________
___________________________________________________________
	___________________________________________________________

29. 	Can you provide us with copies of this material? 
1 ☐ Yes 	2 ☐ No 

(If yes, THANK YOU! Please forward whatever written materials are available with your completed questionnaire.) 

29. 	Does your institution have a specific person in charge of policy decision processes related to students with disabilities, to which NEADS may send a completed version of a report based on this survey? 
1 ☐ Yes 	2 ☐ No 

29a. 	If yes, provide the name and mailing address of this person: 
Name: ____________________________________________________
Address: __________________________________________________
__________________________________________________________
Phone No(s). (please include area code): _________________________
e-mail address: _____________________________________________

SECTION 2 – Accessibility at your educational facility

The following questions are designed to provide us with an assessment of the facilities and services available at your institution in a variety of areas.  Please indicate your evaluation by checking the appropriate boxes ranging from excellent to poor.  The comment space that follows each section allows you to elaborate on your rating, or describe unique situations at your institution.

PART A: Physical Accessibility

30. 	Physical Accessibility: Main Student Services Building
| | Excellent | Good | Fair | Poor | Not Available | Don’t Know
1 | Identified parking spacing | 1 ☐ | 2 ☐ | 3 ☐ | 4 ☐ | 5 ☐ | 6 ☐
2 | Low grade ramps | 1 ☐ | 2 ☐ | 3 ☐ | 4 ☐ | 5 ☐ | 6 ☐
3 | Low pressure doors | 1 ☐ | 2 ☐ | 3 ☐ | 4 ☐ | 5 ☐ | 6 ☐
4 | Wing door handles | 1 ☐ | 2 ☐ | 3 ☐ | 4 ☐ | 5 ☐ | 6 ☐
5 | Wide doorways | 1 ☐ | 2 ☐ | 3 ☐ | 4 ☐ | 5 ☐ | 6 ☐
6 | Automatic doors | 1 ☐ | 2 ☐ | 3 ☐ | 4 ☐ | 5 ☐ | 6 ☐
7 | Accessible washrooms | 1 ☐ | 2 ☐ | 3 ☐ | 4 ☐ | 5 ☐ | 6 ☐
8 | Handrails on walkways | 1 ☐ | 2 ☐ | 3 ☐ | 4 ☐ | 5 ☐ | 6 ☐
9 | Wide aisle areas | 1 ☐ | 2 ☐ | 3 ☐ | 4 ☐ | 5 ☐ | 6 ☐
10 | Accessible service counters | 1 ☐ | 2 ☐ | 3 ☐ | 4 ☐ | 5 ☐ | 6 ☐
11 | Special services for customers with disabilities | 1 ☐ | 2 ☐ | 3 ☐ | 4 ☐ | 5 ☐ | 6 ☐
12 | Elevators in all areas | 1 ☐ | 2 ☐ | 3 ☐ | 4 ☐ | 5 ☐ | 6 ☐
13 | Braille/large print floor elevator numbers | 1 ☐ | 2 ☐ | 3 ☐ | 4 ☐ | 5 ☐ | 6 ☐
14 | Braille/large print elevator buttons | 1 ☐ | 2 ☐ | 3 ☐ | 4 ☐ | 5 ☐ | 6 ☐
15 | Floor bells in elevators | 1 ☐ | 2 ☐ | 3 ☐ | 4 ☐ | 5 ☐ | 6 ☐
16 | Colored strips on stairs | 1 ☐ | 2 ☐ | 3 ☐ | 4 ☐ | 5 ☐ | 6 ☐
17 | Outside lighting | 1 ☐ | 2 ☐ | 3 ☐ | 4 ☐ | 5 ☐ | 6 ☐

	Comments:
	___________________________________________________________
	___________________________________________________________
	___________________________________________________________

31. 	Physical Accessibility: Main Administration Building
| | Excellent | Good | Fair | Poor | Not Available | Don’t Know
1 | Identified parking spacing | 1 ☐ | 2 ☐ | 3 ☐ | 4 ☐ | 5 ☐ | 6 ☐
2 | Low grade ramps | 1 ☐ | 2 ☐ | 3 ☐ | 4 ☐ | 5 ☐ | 6 ☐
3 | Low pressure doors | 1 ☐ | 2 ☐ | 3 ☐ | 4 ☐ | 5 ☐ | 6 ☐
4 | Wing door handles | 1 ☐ | 2 ☐ | 3 ☐ | 4 ☐ | 5 ☐ | 6 ☐
5 | Wide doorways | 1 ☐ | 2 ☐ | 3 ☐ | 4 ☐ | 5 ☐ | 6 ☐
6 | Automatic doors | 1 ☐ | 2 ☐ | 3 ☐ | 4 ☐ | 5 ☐ | 6 ☐
7 | Accessible washrooms | 1 ☐ | 2 ☐ | 3 ☐ | 4 ☐ | 5 ☐ | 6 ☐
8 | Handrails on walkways | 1 ☐ | 2 ☐ | 3 ☐ | 4 ☐ | 5 ☐ | 6 ☐
9 | Wide aisle areas | 1 ☐ | 2 ☐ | 3 ☐ | 4 ☐ | 5 ☐ | 6 ☐
10 | Accessible service counters | 1 ☐ | 2 ☐ | 3 ☐ | 4 ☐ | 5 ☐ | 6 ☐
11 | Special services for customers with disabilities | 1 ☐ | 2 ☐ | 3 ☐ | 4 ☐ | 5 ☐ | 6 ☐
12 | Elevators in all areas | 1 ☐ | 2 ☐ | 3 ☐ | 4 ☐ | 5 ☐ | 6 ☐
13 | Braille/large print floor elevator numbers | 1 ☐ | 2 ☐ | 3 ☐ | 4 ☐ | 5 ☐ | 6 ☐
14 | Braille/large print elevator buttons | 1 ☐ | 2 ☐ | 3 ☐ | 4 ☐ | 5 ☐ | 6 ☐
15 | Floor bells in elevators | 1 ☐ | 2 ☐ | 3 ☐ | 4 ☐ | 5 ☐ | 6 ☐
16 | Colored strips on stairs | 1 ☐ | 2 ☐ | 3 ☐ | 4 ☐ | 5 ☐ | 6 ☐
17 | Outside lighting | 1 ☐ | 2 ☐ | 3 ☐ | 4 ☐ | 5 ☐ | 6 ☐

	Comments:
	___________________________________________________________
	___________________________________________________________
	___________________________________________________________

32. 	Physical Accessibility: Main Library Building
| | Excellent | Good | Fair | Poor | Not Available | Don’t Know
1 | Identified parking spacing | 1 ☐ | 2 ☐ | 3 ☐ | 4 ☐ | 5 ☐ | 6 ☐
2 | Low grade ramps | 1 ☐ | 2 ☐ | 3 ☐ | 4 ☐ | 5 ☐ | 6 ☐
3 | Low pressure doors | 1 ☐ | 2 ☐ | 3 ☐ | 4 ☐ | 5 ☐ | 6 ☐
4 | Wing door handles | 1 ☐ | 2 ☐ | 3 ☐ | 4 ☐ | 5 ☐ | 6 ☐
5 | Wide doorways | 1 ☐ | 2 ☐ | 3 ☐ | 4 ☐ | 5 ☐ | 6 ☐
6 | Automatic doors | 1 ☐ | 2 ☐ | 3 ☐ | 4 ☐ | 5 ☐ | 6 ☐
7 | Accessible washrooms | 1 ☐ | 2 ☐ | 3 ☐ | 4 ☐ | 5 ☐ | 6 ☐
8 | Handrails on walkways | 1 ☐ | 2 ☐ | 3 ☐ | 4 ☐ | 5 ☐ | 6 ☐
9 | Wide aisle areas | 1 ☐ | 2 ☐ | 3 ☐ | 4 ☐ | 5 ☐ | 6 ☐
10 | Accessible service counters | 1 ☐ | 2 ☐ | 3 ☐ | 4 ☐ | 5 ☐ | 6 ☐
11 | Special services for customers with disabilities | 1 ☐ | 2 ☐ | 3 ☐ | 4 ☐ | 5 ☐ | 6 ☐
12 | Elevators in all areas | 1 ☐ | 2 ☐ | 3 ☐ | 4 ☐ | 5 ☐ | 6 ☐
13 | Braille/large print floor elevator numbers | 1 ☐ | 2 ☐ | 3 ☐ | 4 ☐ | 5 ☐ | 6 ☐
14 | Braille/large print elevator buttons | 1 ☐ | 2 ☐ | 3 ☐ | 4 ☐ | 5 ☐ | 6 ☐
15 | Floor bells in elevators | 1 ☐ | 2 ☐ | 3 ☐ | 4 ☐ | 5 ☐ | 6 ☐
16 | Colored strips on stairs | 1 ☐ | 2 ☐ | 3 ☐ | 4 ☐ | 5 ☐ | 6 ☐
17 | Outside lighting | 1 ☐ | 2 ☐ | 3 ☐ | 4 ☐ | 5 ☐ | 6 ☐
18 | Adapted library stations | 1 ☐ | 2 ☐ | 3 ☐ | 4 ☐ | 5 ☐ | 6 ☐

	Comments:
	___________________________________________________________
	___________________________________________________________
	___________________________________________________________

33. 	Physical Accessibility: Main Food Services Building
| | Excellent | Good | Fair | Poor | Not Available | Don’t Know
1 | Identified parking spacing | 1 ☐ | 2 ☐ | 3 ☐ | 4 ☐ | 5 ☐ | 6 ☐
2 | Low grade ramps | 1 ☐ | 2 ☐ | 3 ☐ | 4 ☐ | 5 ☐ | 6 ☐
3 | Low pressure doors | 1 ☐ | 2 ☐ | 3 ☐ | 4 ☐ | 5 ☐ | 6 ☐
4 | Wing door handles | 1 ☐ | 2 ☐ | 3 ☐ | 4 ☐ | 5 ☐ | 6 ☐
5 | Wide doorways | 1 ☐ | 2 ☐ | 3 ☐ | 4 ☐ | 5 ☐ | 6 ☐
6 | Automatic doors | 1 ☐ | 2 ☐ | 3 ☐ | 4 ☐ | 5 ☐ | 6 ☐
7 | Accessible washrooms | 1 ☐ | 2 ☐ | 3 ☐ | 4 ☐ | 5 ☐ | 6 ☐
8 | Handrails on walkways | 1 ☐ | 2 ☐ | 3 ☐ | 4 ☐ | 5 ☐ | 6 ☐
9 | Wide aisle areas | 1 ☐ | 2 ☐ | 3 ☐ | 4 ☐ | 5 ☐ | 6 ☐
10 | Accessible service counters | 1 ☐ | 2 ☐ | 3 ☐ | 4 ☐ | 5 ☐ | 6 ☐
11 | Special services for customers with disabilities | 1 ☐ | 2 ☐ | 3 ☐ | 4 ☐ | 5 ☐ | 6 ☐
12 | Elevators in all areas | 1 ☐ | 2 ☐ | 3 ☐ | 4 ☐ | 5 ☐ | 6 ☐
13 | Braille/large print floor elevator numbers | 1 ☐ | 2 ☐ | 3 ☐ | 4 ☐ | 5 ☐ | 6 ☐
14 | Braille/large print elevator buttons | 1 ☐ | 2 ☐ | 3 ☐ | 4 ☐ | 5 ☐ | 6 ☐
15 | Floor bells in elevators | 1 ☐ | 2 ☐ | 3 ☐ | 4 ☐ | 5 ☐ | 6 ☐
16 | Colored strips on stairs | 1 ☐ | 2 ☐ | 3 ☐ | 4 ☐ | 5 ☐ | 6 ☐
17 | Outside lighting | 1 ☐ | 2 ☐ | 3 ☐ | 4 ☐ | 5 ☐ | 6 ☐

	Comments:
	___________________________________________________________
	___________________________________________________________
	___________________________________________________________

34. 	Physical Accessibility: Bookstore
| | Excellent | Good | Fair | Poor | Not Available | Don’t Know
1 | Identified parking spacing | 1 ☐ | 2 ☐ | 3 ☐ | 4 ☐ | 5 ☐ | 6 ☐
2 | Low grade ramps | 1 ☐ | 2 ☐ | 3 ☐ | 4 ☐ | 5 ☐ | 6 ☐
3 | Low pressure doors | 1 ☐ | 2 ☐ | 3 ☐ | 4 ☐ | 5 ☐ | 6 ☐
4 | Wing door handles | 1 ☐ | 2 ☐ | 3 ☐ | 4 ☐ | 5 ☐ | 6 ☐
5 | Wide doorways | 1 ☐ | 2 ☐ | 3 ☐ | 4 ☐ | 5 ☐ | 6 ☐
6 | Automatic doors | 1 ☐ | 2 ☐ | 3 ☐ | 4 ☐ | 5 ☐ | 6 ☐
7 | Accessible washrooms | 1 ☐ | 2 ☐ | 3 ☐ | 4 ☐ | 5 ☐ | 6 ☐
8 | Handrails on walkways | 1 ☐ | 2 ☐ | 3 ☐ | 4 ☐ | 5 ☐ | 6 ☐
9 | Wide aisle areas | 1 ☐ | 2 ☐ | 3 ☐ | 4 ☐ | 5 ☐ | 6 ☐
10 | Accessible service counters | 1 ☐ | 2 ☐ | 3 ☐ | 4 ☐ | 5 ☐ | 6 ☐
11 | Special services for customers with disabilities | 1 ☐ | 2 ☐ | 3 ☐ | 4 ☐ | 5 ☐ | 6 ☐
12 | Elevators in all areas | 1 ☐ | 2 ☐ | 3 ☐ | 4 ☐ | 5 ☐ | 6 ☐
13 | Braille/large print floor elevator numbers | 1 ☐ | 2 ☐ | 3 ☐ | 4 ☐ | 5 ☐ | 6 ☐
14 | Braille/large print elevator buttons | 1 ☐ | 2 ☐ | 3 ☐ | 4 ☐ | 5 ☐ | 6 ☐
15 | Floor bells in elevators | 1 ☐ | 2 ☐ | 3 ☐ | 4 ☐ | 5 ☐ | 6 ☐
16 | Colored strips on stairs | 1 ☐ | 2 ☐ | 3 ☐ | 4 ☐ | 5 ☐ | 6 ☐
17 | Outside lighting | 1 ☐ | 2 ☐ | 3 ☐ | 4 ☐ | 5 ☐ | 6 ☐

	Comments:
	___________________________________________________________
	___________________________________________________________
	___________________________________________________________

35. 	Physical Accessibility: Special Equipment
| | Excellent | Good | Fair | Poor | Not Available | Don’t Know
1 | Scanner (e.g. OSCAR, Reading Edge) | 1 ☐ | 2 ☐ | 3 ☐ | 4 ☐ | 5 ☐ | 6 ☐
2 | CCTV enlargement system | 1 ☐ | 2 ☐ | 3 ☐ | 4 ☐ | 5 ☐ | 6 ☐
3 | Brailler | 1 ☐ | 2 ☐ | 3 ☐ | 4 ☐ | 5 ☐ | 6 ☐
4 | 4-track tape recorder | 1 ☐ | 2 ☐ | 3 ☐ | 4 ☐ | 5 ☐ | 6 ☐
5 | TDD/TTY (telecommunications devices for the deaf) | 1 ☐ | 2 ☐ | 3 ☐ | 4 ☐ | 5 ☐ | 6 ☐
6 | Phonic ear/FM amplification | 1 ☐ | 2 ☐ | 3 ☐ | 4 ☐ | 5 ☐ | 6 ☐
7 | Acoustically treated rooms | 1 ☐ | 2 ☐ | 3 ☐ | 4 ☐ | 5 ☐ | 6 ☐
8 | Talking calculator | 1 ☐ | 2 ☐ | 3 ☐ | 4 ☐ | 5 ☐ | 6 ☐
9 | Wheelchairs | 1 ☐ | 2 ☐ | 3 ☐ | 4 ☐ | 5 ☐ | 6 ☐
10 | Specialized software for students with learning disabilities | 1 ☐ | 2 ☐ | 3 ☐ | 4 ☐ | 5 ☐ | 6 ☐

	Comments:
	___________________________________________________________
	___________________________________________________________
	___________________________________________________________

36. 	Physical Accessibility: Adaptive Computer Equipment
| | Excellent | Good | Fair | Poor | Not Available | Don’t Know
1 | Voice recognition | 1 ☐ | 2 ☐ | 3 ☐ | 4 ☐ | 5 ☐ | 6 ☐
2 | Internet access | 1 ☐ | 2 ☐ | 3 ☐ | 4 ☐ | 5 ☐ | 6 ☐
3 | Loaner lap-tops | 1 ☐ | 2 ☐ | 3 ☐ | 4 ☐ | 5 ☐ | 6 ☐
4 | Braille printers | 1 ☐ | 2 ☐ | 3 ☐ | 4 ☐ | 5 ☐ | 6 ☐
5 | Braille displays | 1 ☐ | 2 ☐ | 3 ☐ | 4 ☐ | 5 ☐ | 6 ☐
6 | Real-time captioning | 1 ☐ | 2 ☐ | 3 ☐ | 4 ☐ | 5 ☐ | 6 ☐
7 | Screen reading software | 1 ☐ | 2 ☐ | 3 ☐ | 4 ☐ | 5 ☐ | 6 ☐
8 | Refreshable Braille systems | 1 ☐ | 2 ☐ | 3 ☐ | 4 ☐ | 5 ☐ | 6 ☐
9 | Screen enlarging software | 1 ☐ | 2 ☐ | 3 ☐ | 4 ☐ | 5 ☐ | 6 ☐
10 | Adapted computer keyboards | 1 ☐ | 2 ☐ | 3 ☐ | 4 ☐ | 5 ☐ | 6 ☐
11 | Hearing assistance software | 1 ☐ | 2 ☐ | 3 ☐ | 4 ☐ | 5 ☐ | 6 ☐
12 | Adaptive technology training | 1 ☐ | 2 ☐ | 3 ☐ | 4 ☐ | 5 ☐ | 6 ☐
13 | Separate adaptive technology resource centre | 1 ☐ | 2 ☐ | 3 ☐ | 4 ☐ | 5 ☐ | 6 ☐

	Comments:
	___________________________________________________________
	___________________________________________________________
	___________________________________________________________

37. 	Physical Accessibility: Safety, Emergency Features
| | Excellent | Good | Fair | Poor | Not Available | Don’t Know
1 | Safety policies | 1 ☐ | 2 ☐ | 3 ☐ | 4 ☐ | 5 ☐ | 6 ☐
2 | Refuge areas | 1 ☐ | 2 ☐ | 3 ☐ | 4 ☐ | 5 ☐ | 6 ☐
3 | Flashing alarms | 1 ☐ | 2 ☐ | 3 ☐ | 4 ☐ | 5 ☐ | 6 ☐
4 | Emergency procedures | 1 ☐ | 2 ☐ | 3 ☐ | 4 ☐ | 5 ☐ | 6 ☐
5 | Emergency assistance | 1 ☐ | 2 ☐ | 3 ☐ | 4 ☐ | 5 ☐ | 6 ☐

	Comments:
	___________________________________________________________
	___________________________________________________________
	___________________________________________________________

38. 	Physical Accessibility: Access to Labs
| | Excellent | Good | Fair | Poor | Not Available | Don’t Know
1 | Accessible counters in physical science labs | 1 ☐ | 2 ☐ | 3 ☐ | 4 ☐ | 5 ☐ | 6 ☐
2 | Specialized technology in physical science labs | 1 ☐ | 2 ☐ | 3 ☐ | 4 ☐ | 5 ☐ | 6 ☐
3 | Accessible computer labs | 1 ☐ | 2 ☐ | 3 ☐ | 4 ☐ | 5 ☐ | 6 ☐
4 | Adaptive computer technologies in computer labs | 1 ☐ | 2 ☐ | 3 ☐ | 4 ☐ | 5 ☐ | 6 ☐

	Comments:
	___________________________________________________________
	___________________________________________________________
	___________________________________________________________

39 	Physical Accessibility: Access to On-Campus Housing
| | Excellent | Good | Fair | Poor | Not Available | Don’t Know
1 | Identified parking spacing | 1 ☐ | 2 ☐ | 3 ☐ | 4 ☐ | 5 ☐ | 6 ☐
2 | Low grade ramps | 1 ☐ | 2 ☐ | 3 ☐ | 4 ☐ | 5 ☐ | 6 ☐
3 | Low pressure doors | 1 ☐ | 2 ☐ | 3 ☐ | 4 ☐ | 5 ☐ | 6 ☐
4 | Wing door handles | 1 ☐ | 2 ☐ | 3 ☐ | 4 ☐ | 5 ☐ | 6 ☐
5 | Wide doorways | 1 ☐ | 2 ☐ | 3 ☐ | 4 ☐ | 5 ☐ | 6 ☐
6 | Automatic doors | 1 ☐ | 2 ☐ | 3 ☐ | 4 ☐ | 5 ☐ | 6 ☐
7 | Accessible washrooms | 1 ☐ | 2 ☐ | 3 ☐ | 4 ☐ | 5 ☐ | 6 ☐
8 | Handrails on walkways | 1 ☐ | 2 ☐ | 3 ☐ | 4 ☐ | 5 ☐ | 6 ☐
9 | Accessible rooms | 1 ☐ | 2 ☐ | 3 ☐ | 4 ☐ | 5 ☐ | 6 ☐
10 | Attendant care | 1 ☐ | 2 ☐ | 3 ☐ | 4 ☐ | 5 ☐ | 6 ☐

	Comments:
	___________________________________________________________
	___________________________________________________________
	___________________________________________________________

40. 	Physical Accessibility: Adapted On-Campus Transportation
| | Excellent | Good | Fair | Poor | Not Available | Don’t Know
1 | On-campus transportation | 1 ☐ | 2 ☐ | 3 ☐ | 4 ☐ | 5 ☐ | 6 ☐
2 | Convenient hours of service | 1 ☐ | 2 ☐ | 3 ☐ | 4 ☐ | 5 ☐ | 6 ☐
3 | Affordable cost | 1 ☐ | 2 ☐ | 3 ☐ | 4 ☐ | 5 ☐ | 6 ☐

	Comments:
	___________________________________________________________
	___________________________________________________________
	___________________________________________________________

41. 	Physical Accessibility: Other
	Comments:
	___________________________________________________________
	___________________________________________________________
	___________________________________________________________

PART B: Educational Accessibility

42. 	Educational Accessibility: Entrance Examinations
| | Excellent | Good | Fair | Poor | Not Available | Don’t Know
1 | Adaptations for exams | 1 ☐ | 2 ☐ | 3 ☐ | 4 ☐ | 5 ☐ | 6 ☐
2 | Alternative text procedures | 1 ☐ | 2 ☐ | 3 ☐ | 4 ☐ | 5 ☐ | 6 ☐

	Comments:
	___________________________________________________________
	___________________________________________________________
	___________________________________________________________

43. 	Educational Accessibility: Preparation, Registration, Orientation
| | Excellent | Good | Fair | Poor | Not Available | Don’t Know
1 | Registration assistance | 1 ☐ | 2 ☐ | 3 ☐ | 4 ☐ | 5 ☐ | 6 ☐
2 | Pre-registration for students with disabilities | 1 ☐ | 2 ☐ | 3 ☐ | 4 ☐ | 5 ☐ | 6 ☐
3 | TTY registration | 1 ☐ | 2 ☐ | 3 ☐ | 4 ☐ | 5 ☐ | 6 ☐
4 | Study courses | 1 ☐ | 2 ☐ | 3 ☐ | 4 ☐ | 5 ☐ | 6 ☐
5 | Orientation workshops | 1 ☐ | 2 ☐ | 3 ☐ | 4 ☐ | 5 ☐ | 6 ☐
6 | Tours | 1 ☐ | 2 ☐ | 3 ☐ | 4 ☐ | 5 ☐ | 6 ☐
7 | Mobility orientation | 1 ☐ | 2 ☐ | 3 ☐ | 4 ☐ | 5 ☐ | 6 ☐
8 | Classroom relocation | 1 ☐ | 2 ☐ | 3 ☐ | 4 ☐ | 5 ☐ | 6 ☐

	Comments:
	___________________________________________________________
	___________________________________________________________
	___________________________________________________________

44. 	Educational Accessibility: Athletic Programs, Facilities for Persons with Disabilities
| | Excellent | Good | Fair | Poor | Not Available | Don’t Know
1 | Adapted athletics/fitness programs | 1 ☐ | 2 ☐ | 3 ☐ | 4 ☐ | 5 ☐ | 6 ☐
2 | Adapted athletics/fitness equipment | 1 ☐ | 2 ☐ | 3 ☐ | 4 ☐ | 5 ☐ | 6 ☐
3 | Athletic/fitness specialists | 1 ☐ | 2 ☐ | 3 ☐ | 4 ☐ | 5 ☐ | 6 ☐

	Comments:
	___________________________________________________________
	___________________________________________________________
	___________________________________________________________

45. 	Educational Accessibility: Assistance with Lecture Notes, Assignments, Research Papers
| | Excellent | Good | Fair | Poor | Not Available | Don’t Know
1 | Note takers | 1 ☐ | 2 ☐ | 3 ☐ | 4 ☐ | 5 ☐ | 6 ☐
2 | Photocopy pass | 1 ☐ | 2 ☐ | 3 ☐ | 4 ☐ | 5 ☐ | 6 ☐
3 | Computer access | 1 ☐ | 2 ☐ | 3 ☐ | 4 ☐ | 5 ☐ | 6 ☐
4 | Library assistance | 1 ☐ | 2 ☐ | 3 ☐ | 4 ☐ | 5 ☐ | 6 ☐
5 | On-campus readers | 1 ☐ | 2 ☐ | 3 ☐ | 4 ☐ | 5 ☐ | 6 ☐
6 | Editing help | 1 ☐ | 2 ☐ | 3 ☐ | 4 ☐ | 5 ☐ | 6 ☐
7 | Peer tutoring service | 1 ☐ | 2 ☐ | 3 ☐ | 4 ☐ | 5 ☐ | 6 ☐
8 | Proof reading | 1 ☐ | 2 ☐ | 3 ☐ | 4 ☐ | 5 ☐ | 6 ☐
9 | Sign interpreters | 1 ☐ | 2 ☐ | 3 ☐ | 4 ☐ | 5 ☐ | 6 ☐
10 | Oral interpreters | 1 ☐ | 2 ☐ | 3 ☐ | 4 ☐ | 5 ☐ | 6 ☐
11 | Remediation skills | 1 ☐ | 2 ☐ | 3 ☐ | 4 ☐ | 5 ☐ | 6 ☐
12 | NCR paper | 1 ☐ | 2 ☐ | 3 ☐ | 4 ☐ | 5 ☐ | 6 ☐
13 | Lap-top computer | 1 ☐ | 2 ☐ | 3 ☐ | 4 ☐ | 5 ☐ | 6 ☐
14 | Other specialized note-taking services | 1 ☐ | 2 ☐ | 3 ☐ | 4 ☐ | 5 ☐ | 6 ☐

	Comments:
	___________________________________________________________
	___________________________________________________________
	___________________________________________________________

46. 	Educational Accessibility: Text-Book Access
| | Excellent | Good | Fair | Poor | Not Available | Don’t Know
1 | On-Campus large print texts | 1 ☐ | 2 ☐ | 3 ☐ | 4 ☐ | 5 ☐ | 6 ☐
2 | Braille texts | 1 ☐ | 2 ☐ | 3 ☐ | 4 ☐ | 5 ☐ | 6 ☐
3 | Talking books | 1 ☐ | 2 ☐ | 3 ☐ | 4 ☐ | 5 ☐ | 6 ☐
4 | Page turners | 1 ☐ | 2 ☐ | 3 ☐ | 4 ☐ | 5 ☐ | 6 ☐
5 | CCTV | 1 ☐ | 2 ☐ | 3 ☐ | 4 ☐ | 5 ☐ | 6 ☐
6 | Assistance retrieving special texts | 1 ☐ | 2 ☐ | 3 ☐ | 4 ☐ | 5 ☐ | 6 ☐

	Comments:
	___________________________________________________________
	___________________________________________________________
	___________________________________________________________

47. 	Educational Accessibility: Support for Instructors
| | Excellent | Good | Fair | Poor | Not Available | Don’t Know
1 | Assistance with alternate teaching strategies | 1 ☐ | 2 ☐ | 3 ☐ | 4 ☐ | 5 ☐ | 6 ☐
2 | In-service training | 1 ☐ | 2 ☐ | 3 ☐ | 4 ☐ | 5 ☐ | 6 ☐
3 | Case-by-case representation to instructors | 1 ☐ | 2 ☐ | 3 ☐ | 4 ☐ | 5 ☐ | 6 ☐
4 | Notification to instruction by administration | 1 ☐ | 2 ☐ | 3 ☐ | 4 ☐ | 5 ☐ | 6 ☐

	Comments:
	___________________________________________________________
	___________________________________________________________
	___________________________________________________________

48. 	Educational Accessibility: Student Services for Persons with Disabilities
| | Excellent | Good | Fair | Poor | Not Available | Don’t Know
1 | Vocational assessment | 1 ☐ | 2 ☐ | 3 ☐ | 4 ☐ | 5 ☐ | 6 ☐
2 | Psycho-educational assessments | 1 ☐ | 2 ☐ | 3 ☐ | 4 ☐ | 5 ☐ | 6 ☐
3 | Counseling | 1 ☐ | 2 ☐ | 3 ☐ | 4 ☐ | 5 ☐ | 6 ☐
4 | Assistance with job placement | 1 ☐ | 2 ☐ | 3 ☐ | 4 ☐ | 5 ☐ | 6 ☐
5 | Tutoring | 1 ☐ | 2 ☐ | 3 ☐ | 4 ☐ | 5 ☐ | 6 ☐

	Comments:
	___________________________________________________________
	___________________________________________________________
	___________________________________________________________

49. 	Educational Accessibility: Exams, Courses Requirements
| | Excellent | Good | Fair | Poor | Not Available | Don’t Know
1 | Oral examinations | 1 ☐ | 2 ☐ | 3 ☐ | 4 ☐ | 5 ☐ | 6 ☐
2 | Extended exam time | 1 ☐ | 2 ☐ | 3 ☐ | 4 ☐ | 5 ☐ | 6 ☐
3 | Formula to calculate extended time | 1 ☐ | 2 ☐ | 3 ☐ | 4 ☐ | 5 ☐ | 6 ☐
4 | Private rooms for writing | 1 ☐ | 2 ☐ | 3 ☐ | 4 ☐ | 5 ☐ | 6 ☐
5 | Alternative formats | 1 ☐ | 2 ☐ | 3 ☐ | 4 ☐ | 5 ☐ | 6 ☐
6 | Exam study assistance | 1 ☐ | 2 ☐ | 3 ☐ | 4 ☐ | 5 ☐ | 6 ☐
7 | Writers, readers | 1 ☐ | 2 ☐ | 3 ☐ | 4 ☐ | 5 ☐ | 6 ☐
8 | Modification of course/program requirements | 1 ☐ | 2 ☐ | 3 ☐ | 4 ☐ | 5 ☐ | 6 ☐

	Comments:
	___________________________________________________________
	___________________________________________________________
	___________________________________________________________

PART C: Accessibility Programs, Administration

50. 	Accessibility Programs: Administrative Support, Policy
| | Excellent | Good | Fair | Poor | Not Available | Don’t Know
1 | Human resources | 1 ☐ | 2 ☐ | 3 ☐ | 4 ☐ | 5 ☐ | 6 ☐
2 | Required budget for services/programs | 1 ☐ | 2 ☐ | 3 ☐ | 4 ☐ | 5 ☐ | 6 ☐
3 | Program administration | 1 ☐ | 2 ☐ | 3 ☐ | 4 ☐ | 5 ☐ | 6 ☐
4 | Senior administration commitment | 1 ☐ | 2 ☐ | 3 ☐ | 4 ☐ | 5 ☐ | 6 ☐
5 | An overall policy on access for students | 1 ☐ | 2 ☐ | 3 ☐ | 4 ☐ | 5 ☐ | 6 ☐
6 | A policy that covers specific disabilities (e.g. learning disabilities) | 1 ☐ | 2 ☐ | 3 ☐ | 4 ☐ | 5 ☐ | 6 ☐
7 | In-service training for all employees | 1 ☐ | 2 ☐ | 3 ☐ | 4 ☐ | 5 ☐ | 6 ☐
8 | Faculty/departmental cooperation | 1 ☐ | 2 ☐ | 3 ☐ | 4 ☐ | 5 ☐ | 6 ☐

	Comments:
	___________________________________________________________
	___________________________________________________________
	___________________________________________________________

51. 	Volunteer Services
| | Excellent | Good | Fair | Poor | Not Available | Don’t Know
1 | Volunteer services | 1 ☐ | 2 ☐ | 3 ☐ | 4 ☐ | 5 ☐ | 6 ☐

	Comments:
	___________________________________________________________
	___________________________________________________________
	___________________________________________________________

PART D: External/Community Accessibility

52. 	External/Community Accessibility: Liaison with
| | Excellent | Good | Fair | Poor | Not Available | Don’t Know
1 | Public schools | 1 ☐ | 2 ☐ | 3 ☐ | 4 ☐ | 5 ☐ | 6 ☐
2 | CEGEP | 1 ☐ | 2 ☐ | 3 ☐ | 4 ☐ | 5 ☐ | 6 ☐
3 | Other post-secondary institutions | 1 ☐ | 2 ☐ | 3 ☐ | 4 ☐ | 5 ☐ | 6 ☐
4 | Service providers, agencies | 1 ☐ | 2 ☐ | 3 ☐ | 4 ☐ | 5 ☐ | 6 ☐
5 | Government agencies | 1 ☐ | 2 ☐ | 3 ☐ | 4 ☐ | 5 ☐ | 6 ☐
6 | Other resources | 1 ☐ | 2 ☐ | 3 ☐ | 4 ☐ | 5 ☐ | 6 ☐

	Comments:
	___________________________________________________________
	___________________________________________________________
	___________________________________________________________

53. 	External/Community Accessibility: Transportation
| | Excellent | Good | Fair | Poor | Not Available | Don’t Know
1 | Transit on campus | 1 ☐ | 2 ☐ | 3 ☐ | 4 ☐ | 5 ☐ | 6 ☐
2 | Accessible public transit | 1 ☐ | 2 ☐ | 3 ☐ | 4 ☐ | 5 ☐ | 6 ☐
3 | Cost of accessible public transit | 1 ☐ | 2 ☐ | 3 ☐ | 4 ☐ | 5 ☐ | 6 ☐

	Comments:
	___________________________________________________________
	___________________________________________________________
	___________________________________________________________

SECTION 3 – Best Practices of Accessibility

Please give us your overall evaluation of the accessibility features, programs and services of your educational institution.

54. 	In general, in terms of campus accessibility, what do you feel are the three MOST SUCCESSFUL services, programs, or feature of your educational facility?  Why do you think so?
	(1) ___________________________________________________________
	______________________________________________________________
	______________________________________________________________
	______________________________________________________________
	______________________________________________________________

	(2) ___________________________________________________________
	______________________________________________________________
	______________________________________________________________
	______________________________________________________________
	______________________________________________________________

	(3) ___________________________________________________________
	______________________________________________________________
	______________________________________________________________
	______________________________________________________________
	______________________________________________________________

55. 	In general, in terms of campus accessibility, what do you feel are the three LEAST SUCCESSFUL services, programs, or feature of your educational facility?  Why do you think so?
	(1) ___________________________________________________________
	______________________________________________________________
	______________________________________________________________
	______________________________________________________________
	______________________________________________________________

	(2) ___________________________________________________________
	______________________________________________________________
	______________________________________________________________
	______________________________________________________________
	______________________________________________________________

	(3) ___________________________________________________________
	______________________________________________________________
	______________________________________________________________
	______________________________________________________________
	______________________________________________________________

The following questions are designed to elicit your assessment of the priority of accessibility in assisting students with disabilities to make progress at your educational institution.  Please rate the following statements according to the scale provided.

56. 	What priority do you give the financial accessibility of your educational facility in terms of assisting students with disabilities in their studies?
1 ☐ | 2 ☐ | 3 ☐ | 4 ☐
High priority | | | Low priority

57. 	What priority do you give the academic accommodations of your educational facility in terms of assisting students with disabilities in their studies?
1 ☐ | 2 ☐ | 3 ☐ | 4 ☐
High priority | | | Low priority

58. 	What priority do you give the policy/administrative accessibility of your educational facility in terms of assisting students with disabilities in their studies?
1 ☐ | 2 ☐ | 3 ☐ | 4 ☐
High priority | | | Low priority

59. 	What priority do you give the transition to post-secondary education orientation accessibility of your educational facility in terms of assisting students with disabilities in their studies?
1 ☐ | 2 ☐ | 3 ☐ | 4 ☐
High priority | | | Low priority

60. 	What priority do you give the alternative format/materials accessibility of your educational facility in terms of assisting students with disabilities in their studies?
1 ☐ | 2 ☐ | 3 ☐ | 4 ☐
High priority | | | Low priority

61. 	What priority do you give the overall accessibility of your educational facility in terms of assisting students with disabilities in their studies?
1 ☐ | 2 ☐ | 3 ☐ | 4 ☐
High priority | | | Low priority

62. 	Please rank the following feature of accessibility at your educational facility according to how important they are in assisting students with disabilities in their studies.

Rank each of the following features from 1 to 6, with 1 being the most important feature for assisting students, and 6 being the least important feature.

Important: 	DO NOT ASSIGN ANY NUMBER MORE THAN ONCE

| Rank | Example
A. Financial accessibility | ____ | ____
B. Academic accommodation accessibility | ____ | ____
C. Policy / administrative accessibility | ____ | ____
D. Post-secondary orientation accessibility | ____ | ____
E. Alternate format / materials accessibility | ____ | ____
F. Overall accessibility | ____ | ____

Copyright © 1999 – 2003 National Educational Association of Disabled Students (NEADS)