We explored the involvement of students with extensive support needs (ESN) in School-wide Positive Behavioral Interventions and Supports (SWPBIS). We interviewed 15 administrators and special and general educators from elementary schools implementing SWPBIS during the 2019-2020 school year and analyzed responses using qualitative content analysis. In spite of reported challenges related to student characteristics and low expectations among school personnel, participants indicated that students with ESN were taught school-wide expectations and received public acknowledgement at Tier 1, often with adaptations and evidence-based practices, and were considered for Tier 2. Although participants reported commitment to inclusion as a central aspect of SWPBIS, inclusion primarily occurred outside academic classrooms, which limited student involvement across SWPBIS activities. Finally, few participants indicated that students with ESN were involved in SWPBIS data collection activities. Implications include that schools should systematically include students with ESN in all tiers of SWPBIS in such a way that focuses on students' meaningful benefit rather than solely on their physical inclusion and create systems that ensure special and general educators collaborate in SWPBIS implementation. Our findings provide a framework for future studies to identify conditions and effective strategies that ensure SWPBIS benefits all students.