The purpose of this embedded, multiple-case study was to conduct an international exploration of two teacher preparation programs for preservice teachers seeking licensure and specialism to teach students with severe, profound, and multiple disabilities. The study sought to learn about special education teacher preparation practices and structures and to review the programs based on the perceptions of preparedness and application of student-centered pedagogy by program participants, as well as faculty perceptions of competency within the program structure. The conceptual framework considered the core ideas of cultural reciprocity and transformability, where transformability coalesces with growth mindset and ultimately produces increased student learning capacities. The study explored two research questions that examined the curricula and structures of the explored teacher preparation programs and the extent to which participants perceived their degree of preparedness upon program completion. The study sample was comprised of participants and graduates from the explored programs, which offered licensure and specialism to teach students with severe, profound, and multiple disabilities. Select program faculty were also included. To examine the inquiry questions, data collection included document review, survey, and semi-structured interviews. Data were analyzed using descriptive statistics and a thematic analysis involving coding and theming through a flexible and iterative process. Important findings of this study suggest that effective preservice practices include reflective application, and that preservice teachers may require additional courses of study with reflective application to increase competency for students with medical, physical, and sensory needs; legal literacy; and leadership development. Recommendations for future research are presented. [The dissertation citations contained here are published with the permission of ProQuest LLC. Further reproduction is prohibited without permission. Copies of dissertations may be obtained by Telephone (800) 1-800-521-0600. Web page: http://www.proquest.com.bibliotheek.ehb.be/en-US/products/dissertations/individuals.shtml.]