* 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
Another Location
Desks
Additional Building
Stipends for Programs
Busses
Field Trips
More Classified Spport
Parking Lot (build, resurface, etc)
Additional Staff
Chairs
Safety Screening
Landscaping
Cafeteria
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
Newspapers
Fundraising Opportunity
Library Books
Assessment tools / Software
Hygienic items (tissues, sanitizer)
Advertising your Fundraiser
Visual Aids
New Curricula
Printer Paper
Textbooks / Workbooks
Supplies (lined paper, pencils, scissors, chalk, etc)
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
Smartboards
Computers
Toner for Printers
Printers
Document Cameras
Network Maintenance
Document Scanners
Clickers
Software
Computer Monitors
Ipads / Tablets
Learning Games Software
Overhead Projectors
Audio Visual
Computer Programs
Network Upgrade
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
Tools
Supplies / Materials
Additional Staff
Signs / Signage
Plumbing
Paint
Hardware
Security System
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.

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