Grooming Assessment School 2 Survey

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* 3. What is your staff position?

Principal

Assistant Principal

Guidance Counselor

Teacher

Assistant Teacher

Other

(list here)

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* 4. Name of School

School Name

Address:

City/Town:

State:

ZIP:

Country:

Email Address:

Phone Number:

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* 5. Type of school

Elementary

Elementary/Middle

Middle School

Junior High School

Highschool

Junior College

University

Other

(please specify)

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* 6. Is your school...

Public

Private

Charter

Other

(please specify)

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* 7. What is the current student population of your school?

Number of students

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* 8. Estimate the number of each gender currently enrolled

Male

Female

Other

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* 9. Estimate the number of students at your school who suffer from regular grooming/hygiene problems

Estimate here

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* 10. Estimated number of students receiving free and/or reduced lunch

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* 11. Identify the types of grooming/hygiene problems that you observe within your student population (check all that apply)

Uncut hair

Unkept/unstyled hair

Hair that displays dirt or an odor

Body odor

Poor dental habits and/or dental problems

Unclean clothing

Other (please specify)

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* 12. Rank the grooming/hygiene problems that you currently observe within your student population with "1" being most observed and "6" being least observed

Uncut hair

Unkept/unstyled hair

Hair that displays dirt or an odor

Body odor

Poor dental habits and/or dental problems

Unclean clothing

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* 13. Rank the ethnic groups in your student population whom you see suffering from grooming/hygiene problems with "1" being the group most observed and "6" is the group least observed

African American

Caucasian

Asian American

Hispanic

Bi-racial

Other

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* 14. Estimate the number in each ethnic/racial group (place zero if needed)

Hispanic/Latino

American Indian or Alaska Native

Asian

Black or African American

Native Hawaiian or Other Pacific Islander

White

Bi-racial (Two or more races)

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* 15. My students who suffer from grooming/hygiene problems (check all that apply)...

have lower grade point averages than other students

have lower class participation than other students

have lower homework completion that other students

misbehave more than other students

appear to be depressed compared to other students

appear to be hyper-sensitive compared to other students

sits alone in the cafeteria

will not join in group activities

has difficulty making friends

hygiene is a disruption to other students

has difficulty expressing themselves to teachers/administrators

often have health issues

often pretends to be ill

seldom has the necessary school supplies

often needs help to purchase their uniform or school clothing

often has to have hygiene items purchased by teachers/administrators

needs training classes to increase their knowledge concerning grooming and hygiene

needs training classes to increase thier skill concerning grooming and hygiene

parents need training classes to increase their knowledge concerning grooming and hygiene

parents need training classes to increase thier skill concerning grooming and hygiene

Other (please specify)

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* 16. Rank the EDUCATIONAL EFFECTS you have witnessed on the students who suffer from grooming/hygiene problems with "1" being the greatest affected and "4" being the least affected

have lower grade point averages than other students

have lower class participation than other students

have lower homework completion than other students

hygiene is a disruption to other students

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* 17. Rank the SOCIAL EFFECTS that you have witnessed on the students who suffer from grooming/hygiene problems with "1" being the greatest affected and "10" being the least affected

has difficulty making friends

sits alone in the cafeteria

appear to be hyper-sensitive compared to other students

will not join in group activities

appear to be depressed compared to other students

misbehave more than other students

has difficulty expressing themselves to teachers/administrators

often have health issues

often pretends to be ill

often has to have hygiene items purchased by teachers/administrators

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* 18. Select what you believe are the barrier(s) to regular grooming for your students who suffer from grooming/hygiene problems. (select all that apply)

Lack of household income

Parent/guardian lacks the knowledge and skill to care for their grooming and hygiene

Student lack the knowledge and skill to care for their own grooming and hygiene

Lack of transportation to a local barber/beauty salon

Lack of barber/beauty shops in their community

Mental issues

Physical limitations

Suffers from physical neglect by his/her parent or guardian

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* 19. Rank what you believe is the barrier(s) to regular grooming for your students who suffer from grooming/hygiene problems with "1" being the greatest barrier and "8" being the last barrier

Lack of household income

Parent/Guadian lack the knowledge and skill to care for their grooming and hygiene

Student lack the knowledge and skill to care for their grooming and hygiene

Lack of transportation to a located barber/beauty salon

Lack of barber/beauty shops in their community

Mental issues

Physical limitations

Suffers from physical neglect by his/her parent or guardian

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* 20. List any other barrier(s) to regular grooming for your students who suffer from grooming/hygiene problems that are not listed above

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* 21. Select the grooming services needed by your students who suffer from regular grooming/hygiene problems

Haircuts

Hairstyling (including braiding)

Chemical Services

Grooming/Hygiene Products

Classes that increase their knowledge of grooming and hygiene

Classes that increase their skills concerning grooming and hygiene

Other (please specify)

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* 22. Rank the grooming services needed by your students who suffer from regular grooming/hygiene problems from most needed to least needed

Haircuts

Hairstyling (including braiding)

Chemical Services

Grooming/Hygiene Products

Classes that increase their knowledge of grooming and hygiene

Classes that increase their skills concerning grooming and hygiene

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* 23. Select grooming products/equipment that may be needed by your students who suffer from grooming and hygiene problems

Shampoo/Conditioners

Combs

Brushes

Styling aids (gels, greases, oils & creams)

Curling irons/Flat irons

Blow dryers

Hair accessories (barrettes,rubber bands, etc.)

Other (please specify)

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* 24. Rank the grooming products/equipment that may be needed by your students who suffer from grooming and hygiene problems with "1" being most needed to "7" being least needed

Shampoo/Conditioner

Combs

Brushes

Styling aids (gels, greases, oils & creams)

Curling irons/Flat irons

Blow dryers

Hair accessories (barrettes, rubber bands, head bands, etc.)

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* 25. Select how you believe the students will be impacted if they have regular access to no-charge grooming services and products (check all that apply)

Increased class participation

Increased overall motivation concerning their education

Increased grade point average

Increased social reputation

Increased self-expression

Increased self-confidence

Improved behavior

Improved self-image

Reduced health problems

Other (please specify)

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* 26. Rank how you believe the students will be impacted if they have regular access to no-charge grooming services and products with "1" being the greatest impact to "9" being the least impact

Increased class participation

Increased overall motivation concerning their education

Increased grade point average

Increased social reputation

Increased self-expression

Increased self-confidence

Improved behavior

Improved self-image

Reduced health problems

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* 27. Would you like to...

fund the cost of this project yourself

have RBCF the seek the funding for you

speak with the RBCF before you decide

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* 28. As a condition of receiving grooming equipment, products and/or services from RBCF, do you agree to participate in measuring the impact of these our support for not less than a 12-month period?

Yes

Other (please specify)

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* 29. List the name, title, phone, and email of the individual who can be assigned as a contact person for future inquiries concerning the grooming and hygiene of your students

Name:

Title

Email Address:

Phone Number:

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* 1. Date

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* 2. Person filling out this survey

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* 3. What is your staff position?

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* 4. Name of School

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* 5. Type of school

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* 6. Is your school...

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* 7. What is the current student population of your school?

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* 8. Estimate the number of each gender currently enrolled

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* 9. Estimate the number of students at your school who suffer from regular grooming/hygiene problems

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* 10. Estimated number of students receiving free and/or reduced lunch

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* 11. Identify the types of grooming/hygiene problems that you observe within your student population (check all that apply)

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* 12. Rank the grooming/hygiene problems that you currently observe within your student population with "1" being most observed and "6" being least observed

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* 13. Rank the ethnic groups in your student population whom you see suffering from grooming/hygiene problems with "1" being the group most observed and "6" is the group least observed

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* 14. Estimate the number in each ethnic/racial group (place zero if needed)

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* 15. My students who suffer from grooming/hygiene problems (check all that apply)...

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* 16. Rank the EDUCATIONAL EFFECTS you have witnessed on the students who suffer from grooming/hygiene problems with "1" being the greatest affected and "4" being the least affected

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* 17. Rank the SOCIAL EFFECTS that you have witnessed on the students who suffer from grooming/hygiene problems with "1" being the greatest affected and "10" being the least affected

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* 18. Select what you believe are the barrier(s) to regular grooming for your students who suffer from grooming/hygiene problems. (select all that apply)

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* 19. Rank what you believe is the barrier(s) to regular grooming for your students who suffer from grooming/hygiene problems with "1" being the greatest barrier and "8" being the last barrier

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* 20. List any other barrier(s) to regular grooming for your students who suffer from grooming/hygiene problems that are not listed above

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* 21. Select the grooming services needed by your students who suffer from regular grooming/hygiene problems

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* 22. Rank the grooming services needed by your students who suffer from regular grooming/hygiene problems from most needed to least needed

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* 23. Select grooming products/equipment that may be needed by your students who suffer from grooming and hygiene problems

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* 24. Rank the grooming products/equipment that may be needed by your students who suffer from grooming and hygiene problems with "1" being most needed to "7" being least needed

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* 25. Select how you believe the students will be impacted if they have regular access to no-charge grooming services and products (check all that apply)

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* 26. Rank how you believe the students will be impacted if they have regular access to no-charge grooming services and products with "1" being the greatest impact to "9" being the least impact

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* 27. Would you like to...

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* 28. As a condition of receiving grooming equipment, products and/or services from RBCF, do you agree to participate in measuring the impact of these our support for not less than a 12-month period?

Question Title

* 29. List the name, title, phone, and email of the individual who can be assigned as a contact person for future inquiries concerning the grooming and hygiene of your students