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This funding is for the purpose of providing tampons, sanitary napkins, and other related
products in the school nurse's office, student health center, or other area designated by the
school administration for all middle school, junior high, and high school buildings in which
there are students in grades 6-12, at no charge to students. This survey is a
reflection of the quality, impact, and efficiency of the Feminine Hygiene Products Grant
Program.

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* 1. Name of school nurse or other designee completing this survey:

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* 2. School nurse or other designee's email address:

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* 3. Select your local education agency (LEA) name from the appropriate drop-down list:
LEA Name (A-H)

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* LEA Name (I-N):

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* LEA Name (O-Z):

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* 4. Regarding program quality, please check the answer that best applies to the LEA:

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* 5. Regarding the program's impact, please check ALL that apply:

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* 6. Regarding the program's efficiency, the LEA was made aware in a timely fashion of the Feminine Hygiene Grant through one or more of the following measures: Department of Elementary and Secondary Education (DESE) Administrative Memo, DESE website, DESE listserv, Department of Health and Senior Services (DHSS), etc.

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* 7. Regarding the program's efficiency, the LEA was able to spend all allocated
funds to purchase feminine hygiene products.

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* 8. Regarding the program's efficiency, the LEA found the reimbursement process easy and accessible.

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* 9. Are there any additional feminine hygiene products that would be helpful to female students that are not currently allowable? Please list.

The Department of Elementary and Secondary Education does not discriminate on the basis of race, color, religion, gender, gender identity, sexual orientation, national origin, age, veteran status, mental or physical disability, or any other basis prohibited by statute in its programs and activities. Inquiries related to department programs and to the location of services, activities, and facilities that are accessible by persons with disabilities may be directed to the Jefferson State Office Building, Director of Civil Rights Compliance and MOA Coordinator (Title VI/Title VII/Title IX/504/ADA/ADAAA/Age Act/GINA/USDA Title VI), 5th Floor, 205 Jefferson Street, P.O. Box 480, Jefferson City, MO 65102-0480; telephone number 573-526-4757 or TTY 800-735-2966; email civilrights@dese.mo.gov.

 
MO 500-3457 (09-23)
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