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

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