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1. School's Name

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2. Grade Level (please select all that apply)

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3. Who are the people in your building (teachers, staff, administrators, students, parents, community members) currently focusing explicitly on school climate issues?

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4. Are you currently implementing any school climate programs (please select all that apply)?

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5. Are you currently working with any school climate partners/practitioners (please check all that apply)?

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6. What are the greatest climate needs in your building right now?

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7. I am interested or would like more information on (please select all that apply):

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8. Principal's Name

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