Thank you for participating in the RBCF grooming needs survey. This survey measure 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

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 the students at your school who suffer from regular grooming/hygiene problems

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

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

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

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* 13. 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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* 14. 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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* 15. 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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* 16. Rank what you believe are the barrier(s) to regular grooming for your students who suffer from grooming/hygiene problems wih "1" being the greatest barrier and "8" being the least barrier

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

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

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

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* 22. Select how you beleive 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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* 23. Rank how you beleive 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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* 24. Would you like to...

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

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