An important contemporary issue in special education is the extent to which students with a disability are included in all mainstream educational activities, including educational accountability. In line with other Western countries, the extent of national testing conducted by Australian schools will increase in the near future. At the moment, the participation of students with a disability in national testing is low and it is unlikely to significantly increase without the development of clear guidelines about allowable accommodations in testing, and the development of alternative assessment protocols for students with high support needs. This paper reviews the recent literature on both accommodations and alternative testing for students with a disability and makes a number of recommendations about the inclusion of students with a disability in national and in school-based testing.