Client Intake Questionnaire

Teacher

Teachers, Welcome to Room Redefined!

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)

How long have you worked at this school?(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

Anticipated opening date for the school (if known)

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

Yes

Other

Date your school opened (if known)

Address of school (if different from above)

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

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)

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

Project Information

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

Planning/coordinating move to new location

Space planning to how we can best use spaces within the school site.

Strategic planning regrading students movements throughout the site

Furnishing of classrooms at the school

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

Furnishing of office/administrative space

Furnishing/organizing of teacher workspaces

General set-up of classroom(s) (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

Development and implementation of storage solutions for shared classroom/school supplies

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

Organizational strategies within my own classroom

Other

Other (Please specify)

If you are a classroom teacher, please share what grade, number of students, and number of classes at this level?

What are the demographics of your school population?(Required)

Briefly describe any programming that makes your school unique.(Required)

Briefly describe any characteristics that make your school unique.(Required)

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

Space planning: how we can best use the spaces within the school site

Strategic planning regarding student movement throughout the site

Furnishing of classrooms at the school

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

Furnishing of offices/administrative spaces

Furnishing/organizing of teacher workspaces

General set-up of classroom(s) (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

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

Organizational strategies within my own classroom

Other (please specify)

Project Timing

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

Do you have deadlines by which the project/phases of the project need to be completed? Please explain.

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)

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