A survey instrument is presented that was used in a national survey of 160 colleges and universities to explore facilities and services to students with orthopedic disabilities. The survey contains 33 items that focus on the following areas: structural accessibility, academic accessibility, dorm-living, and recreational opportunities. The total reliability of the instrument is 0.88 (Alpha). Each item is to be rated on a 5-point scale, with 5 meaning the participant strongly agrees with the presented statement and 1 meaning the participant strongly disagrees with the statement. Statements address the presence of ramps, curb cuts, reserved parking places, accessible elevators, accessible restrooms, accessible libraries, classroom accessibility, adapted transportation systems, accessible laundry facilities, accessible fire exits, personal care assistants, wheelchair repair, service dogs, and adapted sports. (CR)