At present, English holds a significant importance in numerous countries worldwide, including Thailand where learning English is compulsory for students. For students with hearing impairment, however, due to their physical limitations, English instruction is different from that of other students. Additionally, students with hearing impairment have different and specific needs for English as a Foreign Language (EFL) instruction. To design and develop an appropriate EFL course for them, we collected 68 questionnaires from Thai senior secondary school students at two schools for the deaf in Bangkok, Thailand, and 15 from stakeholders including Thai EFL teachers and executives at schools for the deaf in Bangkok, sign language interpreters, and Thai officers from the Special Education Bureau. Then, eight senior secondary school students with hearing impairment and six stakeholders were randomly selected for an interview, and eight structured classroom observations were made at the two schools for the deaf in Bangkok. The data were then quantitatively and qualitatively analyzed and reported using a weaving approach. The findings revealed a wealth of both implications and recommendations (i.e., in course content, schedule management, instructional activities, methods and materials, instructional languages, teacher roles, classroom setting and environment, and assessment) useful for developing a proper EFL course for Thai senior secondary school students with hearing impairment.