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