Client Intake Questionnaire

Community Member

Welcome to Room Redefined: Community Member

Thank you for taking the time to complete this questionnaire. At Room Redefined, we are committed to bringing about personalized solutions and lasting change to support your work as educators. Asking these questions helps us better understand your hopes and develop school-based supports and solutions.

Wherever you are at in your school journey, we look forward to helping bring about “your space, but better.”

Contact Information

Name(Required)

First Last

School Name(Required)

Address(Required)

Street Address Address Line 2 City State ZIP Code

Email(Required)

Phone(Required)

School Website

Your Role(Required)

Preferred way to contact you(Required)

Phone Call

Is this a new school in development or a school that is already open and serving students?(Required)

New School

Already open

Date your school opened (if known)

Briefly describe your school site (purpose built, etc.)

If this is a new school, is there already a site for the school?

Yes

Other

If you have a site for the new school, what is the address? (if different from contact info above)

Anticipated opening date for the school (if known)

Will this be a temporary or permanent site for the school?

Temporary

Permanent

If temporary, how long do you anticipate being at this site?(Required)

Please enter the number of students, number of teachers of teachers and number of rooms you want to accommodate for each grade level you will be offering. (Please enter NA if you do not plan to provide for a particular level.)

ECE/Pre-K

Kindergarten

1st Grade

2nd Grade

3rd Grade

4th Grade

5th Grade

6th Grade

7th Grade

8th Grade

9th Grade

10th Grade

11th Grade

12th Grade

Any additional information about the number of students/rooms/teachers you wish to share?

What are the demographics of your school population?

What special needs are represented in your student body that we need to take into account?

Briefly describe any programming that makes your school unique.

Hidden

What services are you interested in receiving more information about (check all that apply)

Space planning/how to best use your spaces within the school site

Strategic planning regrading students movements throughout the site

Furnishing of classrooms

Furnishing of shared school spaces (i.e lunchrooms, gathering spaces, everyway, library, play spaces, etc. )

Furnishing of office / administrative space

Furnishing of teacher workspaces

General classroom set-up (i.e furniture arrangement, placement of whiteboards etc. )

Set-up of shared school spaces

Set-up of offices / administrator spaces

Development and implementation of storage solutions for students belongings

In service planning/facilitation to develop shared plans regarding use of school envirnment

Individual teacher support and coaching

Other

What services are you interested in receiving more information about (Check all that apply)(Required)

Planning/coordinating move to new location

Space planning/how to best use your spaces within the school site

Strategic planning regarding student movement throughout the site

Furnishing of classrooms

Furnishing of shared school spaces (i.e lunchrooms, gathering spaces, entryways, library, play spaces, etc.)

Furnishing of offices/administrative spaces

Furnishing of teacher workspaces

General classroom set-up (i.e. furniture arrangement, placement of whiteboards, etc.)

Set-up of shared school spaces

Set-up of offices administrative spaces

Development and implementation of storage solutions for student belongings

Development and implementation of storage solutions for classroom/school supplies

Improve organization systems in classroom spaces

Improve organization systems in shared school spaces

Improve organization systems in offices/administrative spaces

In-service planning/facilitation to develop shared plans regarding use of school environment

Individual teacher support and coaching

Other (please specify)

Other (please specify)(Required)

Project Timing

Do you have a time frame in mind for beginning your work with Room Redefined?(Required)

Do you have a completion date in mind for the project/phases of the project? Explain.(Required)

Please share anything else you would like us to know about your school and/or your project.

How did you hear about Room Redefined?(Required)

CAPTCHA

Phone

This field is for validation purposes and should be left unchanged.