* 1. Which of the following best describes your role:

* 2. Which of the following are you associated with:

* 3. Please indicate level:

* 4. For each of the following ENVIRONMENTAL needs, please rate the level of priority that pertain to you and your students, where 5 means it's one of your highest priorities, and 1 means it's one of your lowest priorities:

  Highest Priority - 5 4 3 2 1 - Lowest Priority
Landscaping
Cafeteria
Desks
Another Location
More Classified Spport
Stipends for Programs
Safety Screening
Busses
Parking Lot (build, resurface, etc)
Chairs
Additional Building
Field Trips
Additional Staff
Other

* 5. For each of the following MATERIAL needs, please rate the level of priority that pertains to you and your students, where 5 means it's one of your highest priorities, and 1 means it's one of your lowest priorities:

  Highest Priority - 5 4 3 2 1 - Lowest Priority
Printer Paper
Library Books
Supplies (lined paper, pencils, scissors, chalk, etc)
New Curricula
Advertising your Fundraiser
Fundraising Opportunity
Visual Aids
Assessment tools / Software
Hygienic items (tissues, sanitizer)
Newspapers
Textbooks / Workbooks
Other

* 6. For each of the following TECHNOLOGY needs, please rate the level of priority that pertains to you and your students, where 5 means it's one of your highest priorities, and 1 means it's one of your lowest priorities:

  Highest Priority - 5 4 3 2 1 - Lowest Priority
Printers
Audio Visual
Network Upgrade
Document Scanners
Computers
Document Cameras
Computer Programs
Ipads / Tablets
Toner for Printers
Learning Games Software
Smartboards
Clickers
Software
Computer Monitors
Network Maintenance
Overhead Projectors
Other

* 7. For each of the following FACILITIES / MAINTENANCE needs, please rate the level of priority that pertains to you and your students, where 5 means it's one of your highest priorities, and 1 means it's one of your lowest priorities:

  Highest Priority - 5 4 3 2 1 - Lowest Priority
Additional Staff
Plumbing
Tools
Security System
Hardware
Paint
Supplies / Materials
Signs / Signage
Other

* 8. Comments (Optional)

* 9. Name and email (optional). In order to be entered into the drawing for a $100 Visa gift card, we need your name and email address. This information is for the drawing only. We will not use this information for any other purpose.

T