Support Choices Form
Support Choices Form
Student accommodation check-in & preference record
Student Decision Record
Student Name
Date
Class / Subject
Teacher / Case Mgr
Your voice matters: You have the right to communicate how you want to work today. Accommodations are always here to support you, but choosing to try a task independently is your choice. This form records your decision for today's activity.
1
Accommodation Offered for Today's Task
Check all that apply
Extra time on task / test Read-aloud / Audio reader Quiet space / Separate room Graphic organizer / Guided notes Speech-to-text / Scribe Frequent breaks / Movement Calculator / Math formula tool Reduced answer choices / chunks
Other:
2
My Choice & Reason Today
Select your choice and best match
For this assignment, I choose to:
Work independently without this tool Try on my own first, decide later Use a personal strategy instead
Why this fits me best today:
I feel confident and ready to try I want to challenge myself The accommodation feels distracting right now
Other:
3
What I Need Next (My Plan)
Accommodations remain available
If I get stuck, I will ask for the accommodation I prefer to finish the assignment as is I want to check in before turning it in
Optional student note:
4
Documentation & Pattern Tracking
Official IEP accommodation documentation
Student Confirmation
I confirm that my accommodation was made available to me today, and I chose not to use it for this activity.
Student Signature / Initials
Time / Date
Teacher / Staff Record
Offered Declined
Refusal / Choice History Pattern:
First time Occasional (2-3x) Frequent pattern
Staff Signature / Initials
Case Mgr Notified
Student Self-Advocacy & Accommodation Tracking Retain copy for IEP progress monitoring / case file
