Appendix G-17 Screen Shots - Web-based District Survey

Form Approved

OMB No: 0920-0445

Expiration Date: xx/xx/xxxx

Screen Shots

Appendix G-17

Login Screen

District Confirmation Screen

Consent Statement

Questionnaires Menu / Home Page

Health Education – Special Instructions

H ealth Education –Questions

Physical Education – Special Instructions

Physical Education –Questions

Nutrition Services – Special Instructions

Nutrition Services –Questions

Mental Health and Social Services – Special Instructions

Mental Health and Social Services –Questions

Health Services – Special Instructions

Health Services –Questions

Faculty and Staff Health Promotion – Special Instructions

Faculty and Staff Health Promotion –Questions

Healthy and Safe School Environment – Special Instructions

H ealthy and Safe School Environment –Questions