Thank you for participating in the RBCF grooming needs survey. This survey measures the grooming and hygienic needs of your student population.

Disclaimer: Please note that completing our online assessment does not guarantee the delivery of no-charge grooming services. There is no deadline to complete this survey. Your participation in this survey is completely voluntary.

We advise that you...
1) Print this form
2) Compile your answers
3) Return, and complete the online version

*DO NOT ENTER COMMAS WITHIN ANY NUMERICAL TEXTBOX

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1. Date (Required.)

Date

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2. Person filling out this survey (Required.)

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3. What is your staff position? (Required.)

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4. Name of School (Required.)

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5. Type of school (Required.)

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6. Is your school... (Required.)

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7. What is the current student population of your school? (Required.)

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8. Estimate the number of each gender currently enrolled (Required.)

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

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10. Estimated number of students receiving free and/or reduced lunch  (Required.)

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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) (Required.)

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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? (Required.)

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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 (Required.)

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