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