This article shares key findings from classroom observations and teacher interviews which shed light on the classroom practices to support the English language development of students who are dually identified as English learners and students with significant cognitive disabilities. Of these practices, drills and repetition, read aloud, and total physical response were among the more frequently observed interactive tasks. The most frequently observed cognitive strategies were listen/repeat, use of imagery, and use of graphic organizers. The most common social/affective strategies were asking questions and encouragement/lowering affective filter. Pointing and verbal response were the most common ways that students demonstrated learning in the classroom. Picture cards was another typical approach. When asked about the development of alternate English language proficiency assessment, educators said that assessment should be interactive and include real images that are familiar to the student. They also emphasized that assessment should also relate to the student’s experiences and the classroom curriculum. Educators frequently reported that they received professional development in the form of teacher-to-teacher activities or that they received no support calling attention to the need for on-going professional development for educators.