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