* 1. What is your first name?

* 2. What is your last name?

* 3. At what email address would you like to be contacted?

* 4. What is your mobile phone number?

* 5. Home phone?

* 6. How do you prefer to be contacted?

* 7. What is your street address?

* 8. In what city do you live?

* 9. Zip code?

* 10. Island?

* 11. Occupation?

* 12. How many students do you have in Hawaii schools?

* 13. Student Ages? (for multiples, separate with commas)

* 14. School(s) attending? (for multiples, separate with commas)

* 15. What school would you like to serve as a Parent Ambassador?

* 16. Are you a member of any parent groups? (PTA, PTSA, PTO, other?)

* 17. Please rate the importance of the following possible areas of concern. (rate each area)

  Most Important Very Important Important Fairly Important Not Important
High stakes testing/ESSA
Teacher Salaries
Need for expanded pre-school/kindergarten
School facilities (eg. air conditioning, etc.)
Legislative advocacy (education policy and issues)
Special Education
Class Size
Absenteeism
Equity

* 18. Any other comments or suggestions?

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