St. Cloud State University Technology Network Interest Survey The St. Cloud State University Technology Network is a collaborative network of 30 schools supported by St. Cloud State University, k-12 schools and businesses around the state. Please complete the questions below to provide information on your school. This information will be used as an application to the network and to identify business partners in your area. Question Title * 1. Contact Information Name * School Building * School District * City/Town * ZIP/Postal Code * Cell phone # Email Address * Phone Number * Question Title * 2. Please provide demographic data for your district. Less than 10% 11-20% 21-30% 31-40% 41-50% Greater than 50% N/A Free or reduced lunch students Free or reduced lunch students Less than 10% Free or reduced lunch students 11-20% Free or reduced lunch students 21-30% Free or reduced lunch students 31-40% Free or reduced lunch students 41-50% Free or reduced lunch students Greater than 50% Free or reduced lunch students N/A African American Students African American Students Less than 10% African American Students 11-20% African American Students 21-30% African American Students 31-40% African American Students 41-50% African American Students Greater than 50% African American Students N/A Asian / Pacific Islander Students Asian / Pacific Islander Students Less than 10% Asian / Pacific Islander Students 11-20% Asian / Pacific Islander Students 21-30% Asian / Pacific Islander Students 31-40% Asian / Pacific Islander Students 41-50% Asian / Pacific Islander Students Greater than 50% Asian / Pacific Islander Students N/A Hispanic / Latino Students Hispanic / Latino Students Less than 10% Hispanic / Latino Students 11-20% Hispanic / Latino Students 21-30% Hispanic / Latino Students 31-40% Hispanic / Latino Students 41-50% Hispanic / Latino Students Greater than 50% Hispanic / Latino Students N/A Native American Students Native American Students Less than 10% Native American Students 11-20% Native American Students 21-30% Native American Students 31-40% Native American Students 41-50% Native American Students Greater than 50% Native American Students N/A Somalian Students Somalian Students Less than 10% Somalian Students 11-20% Somalian Students 21-30% Somalian Students 31-40% Somalian Students 41-50% Somalian Students Greater than 50% Somalian Students N/A White Caucasian White Caucasian Less than 10% White Caucasian 11-20% White Caucasian 21-30% White Caucasian 31-40% White Caucasian 41-50% White Caucasian Greater than 50% White Caucasian N/A Question Title * 3. What is the total enrollment of your school district? Question Title * 4. What is the total enrollment of your high school? Question Title * 5. What are the greatest needs of your program? Need #1 Need #2 Need #3 Question Title * 6. List the teacher or staff you plan to include in the project. Name e-mail address School phone number Cell phone number Question Title * 7. List the teacher or staff you plan to include in the project. Name e-mail address School phone number Cell phone number Question Title * 8. List the teacher or staff you plan to include in the project. Name e-mail address School phone number Cell phone number Question Title * 9. List the teacher or staff you plan to include in the project. Name e-mail address School phone number Cell phone number Question Title * 10. List the teacher or staff you plan to include in the project. Name e-mail address School phone number Cell phone number Question Title * 11. List business partners you plan to include or could be a sponsor of the project. Name e-mail address phone number Cell phone number Question Title * 12. List business partners you plan to include or could be a sponsor of the project. Name e-mail address phone number Cell phone number Question Title * 13. List business partners you plan to include or could be a sponsor of the project. Name e-mail address phone number Cell phone number Submit Grant Application