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