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