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