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

T