1 

### 2014 **- 2015	BASE**  **C harter	School	Facilities	Survey**  **Public	Burden	Statement:** According	to	the	Paperwork	Reduction	Act	of	1995,	no	persons	are	required	to	respond	to	a	collection	of	information	unless such	collection	displays	a	valid	OMB	control	number. Public	reporting	burden	for	this	collection	of	information	is	estimated to	average	3	hours	per	response,	including	time	for	reviewing	instructions,	searching	existing	data	sources,	gathering	and maintaining	the	data	needed,	and	completing	and	reviewing	the	collection	of	information. The	obligation	to	respond	to	this collection	is	vo luntary	(Part	B	section	5201	of	the	Elementary	and	Secondary	Education	Act).	Send	comments	regarding	the burden	estimate	or	any	other	aspect	of	this	collection	of	information,	including	suggestions	for	reducing	this	burden,	to	the U.S.	Department	of	Education,	400	Maryland	Ave.,	SW,	Washington,	DC	20210
- 4537	or	email ICDocketMgr@ed.gov and reference	the	OMB	Control	Number	1855
- 0024 Note:	Please	do	not	return	the	completed	Charter	School	Facilities	National Questionnaire	to	this	address. 

### Section 1 **- General Facilit** **y Information**  **Section 1.1 –**  **Basic Facility Information S1.1.q1**  Please indicate the grade levels served in this facility (select all that apply) 

### S1.1.q1.1 Pre
- K 

### S1.1.q1. **2** Kindergarten 

### S1.1.q1. **3** 1 st grade 

### S1.1.q1.4 2 nd grade 

### S1.1.q1.5 3 rd grade 

### S1.1.q1.6 4th grade 

### S1.1.q1.7 5th grade 

### S1.1.q1.8 6th grade 

### S1.1.q1.9 7th grade 

### S1.1.q1.10 8th grade 

### S1.1.q1.11 9th grade 

### S1.1.q1.12 10 th grade 

### S1.1.q1.13 11 th grade 

### S1.1.q1.14 12 th grade 

### S1.1.q1.15 Beyond 12 th grade **S1.1.q 2**  **How many years has the school been in operation including the**  **2014 -**  **2015 school year**  **? S1.1.q**  **3 Does the**  **school use an educational model that has explicit space/equipment implications f or**  **the facility?**

1. No, the educational model has typical educational facility requirements 2. Yes, Montessori model 3. Yes, Expeditionary Learning model 4. Yes, Math/Science/Technology (STEM) model 5. Yes, School of the Arts model 6. Yes, blended learning model. 7. Yes, O ther2 **S1.1.q 4**  **For the 2014** **- 2015**  **school year, w hat is the usual maximum number of students served in the facility at any one**  **time?** Note: Answer 450 if the school has 475 students enrolled but 50 are half

-day kindergartners and 25 are served in the morning and 25 are served in the afternoon . If the kindergartners are full

-day or all 50 are served in the morning or afternoon, answer 475. Answer 200 if 200 students are in a day program and 150 are in a night program and the programs do not overlap. Answer 450 for a multi

- track school that has an enrollment of 600 students, but only serves 450 during any track. Also, if sharing a facility with another school, be sure to report only the number usually in your school. Do not include the students from the shared school. **S1.1.q 5**  **As of**  **October 1st, 201 4** **, how many eligible students (i.e., school age, grade level appropriate) remained on your waiting list?**  (If none, enter 0; do not include children who are not yet old enough to attend the school.) **S1.1.q 6**  **In the last t hree years (201**  **2 -**  **2013, 2013 -**  **2014, an d 2014** **- 2015**  **), how many student instruction**  **days did the school have to be closed due to facilities**  **- related**  **maintenance issues (e.g., broken pipes, a furnace that needed repairing, air quality**  **issues, etc.)?** (Enter whole numbers only) Please indicate to what extent you agree with the following statements **:**

Strongly Disagree Disagree Agree Strongly Agree **S1.1.q 7**  **a Students with disabilities have access to the entire school facility.**  **S1.1.q 7**  **b T**  **he school facility**  **contributes to student**  **learning .**  **S1.1.q 7**  **c The school facility contributes to a positive school climate** **/culture. S1.1.q7d**  **The school facility has the amenities , including specialized classrooms,**  **to best implement**  **its educational program.**  **S1.1.q8 Please indicate whic**  **h of the following issues, if any, the school experienced that delayed**  **the school from opening as planned: (Select all that apply)**  **S1.1.q8.1 None, the school was able to open on the date planned.**  **S1.1.q8.2 The school experienced zoning issues wi** **th its cho sen facility that**  **delayed when the school could open. S1.1.q8.3**  **The school experienced issues obtaining an occupancy permit that**  **delayed when the school could open. S1.1.q8.4**  **The school experienced problems finding a suitable facility in**  **the desired geographic area that**  **delayed when the**

**school could open. S1.1.q8.5**  **The school experienced problems finding an affordable facility in the**  **desired geographic area that delayed when the** 

**school could open. S1.1.**  **q8.6 The school experienced difficulties in**  **obtaining financing for the renovation of the chosen facility that delayed when**

**the school could open. S1.1.q8.7**  **The school experienced difficulties in obtaining financing for the purchase of the chosen facility that delayed when**

**the school could open. S1.**  **1.q8.8 The school experienced difficulties in obtaining financing for the new construction of a facility that delayed when the** 

**school could open. S1.1.q8.9**  **a The school experienced other facility related issues that delayed when the school could open.**  **S1.1. q8.9b.**  **Please describe the other facility related issue the school experienced that delayed when the school could open.** 

### Section 1.2 **– Future Facility Plans**  **S1.2.q 1**  **W hat is the school’s desired enrollment**  **in five years (2018** **- 2019**  **) ?**  **S1.2.q 2**  **Does the school’s**  **current facility have adequate space f or the desired**  **enrollment five years from**  **now (2018 -**  **2019 )**  **? [If**  **YES , skip to S2.1.q1]**  Yes No3 **S1.2.q 3**  **Does the school have a feasible, specific facilit y**  **plan to construct or acquire adequate space for the desired enrollment five years from now**  **(2018 -**  **2019 )**  **?** Yes No


### Section 2 **– General Facility Information**  **Section 2.1 –**  **General Characteristics S2.1.q1**  **In which time period**  **was the original (main)**  **facility construction completed?** 1. prior to 1920 2. 1920s
- 1940s 3. 1 950s
- 1960s 4. 1970s
- 1980s 5. 1990s
- 2000s 6. 2010 or newer **S2.1.q 2**  **Was the**  **original facility**  **constructed to be a school? (Note**  **: If**  **school is made up of all modular/trailers that were put in**  **place for**  **the sole**  **purpose of**  **being a**  **school, please**  **answer “NO”**  **to this**  **question. We**  **are only**  **asking about**  **permanent facilities.**  **)** Yes No **S2.1.q 3**  **Please select the statement that best applies to the permanence of the school’s current facility:**

1. The school has only trailers/modular classrooms. 2. The school has only permanent building(s ) , including prefabricated buildings. 3. The school has both trailers/modular classrooms and a permanent building(s). S2.1.q4 Which of the following does the school have in place to address the schools facility needs over the next five years? (Please select all that apply). 1. Strategic facilities plan (Strategic facilities plan identifies the type, quantify and location of spaces required to fully support the school’s mission and sho uld be framed within the organization’s larger strategic vision). 2. School facilities committee. 3. Master Plan (Master plan, facility master plan or campus master plan provides a framework for the physical environments that incorporate the buildings). 4. Other, p lease describe. 

### Section **2.2 –**  **Facility Ownership** Please provide the approximate percentage (between 0 and 100) of the school’s FACILITY that is owned by the following (NOTE: the sum of the percentages listed should add to 100 ) **:** 0 10 20 30 40 50 60 70 80 90 100% **S2.2.q 1a**  **The school (or building corporation formed by the school)**  **S2.2.q1 b**  **A school district S2.2.q1**  **c The state**  **S2.2.q1 d**  **A government entity other than a school district S2.2.q1**  **e A for** **- profit**  **company S2.2.q1**  **f A**  **non -**  **profit organization unrelated**  **to the school**4 **S2.2.q1 g**  **A non -**  **profit organization related**  **to the school (e.g.**  **, the non -**  **profit founded the school or has a partnership with the school**  **)**

Please provide the approximate percentage (between 0 and 100) of the school’s LAND that is owned by the following (NOTE: the sum of the percentages listed should add to 100 ) **:** 0 10 20 30 40 50 60 70 80 90 100% **S2.2.q2 a**  **The school (or building corporation formed by the school) S2.2.q**  **2b A school district**  **S2.2.q 2c**  **The state S2.2.q**  **2d A government entity other than a school district**  **S2.2.q 2e**  **A for -**  **profit company S2.2.q**  **2f A non**  **- profit organization**  **unrelated to the school**  **S2.2.q 2g**  **A non -**  **profit organization related**  **to the school (e.g.**  **, the non -**  **profit founded the school or has a partnership with the**  **school )**  

### Section 2.3 **– Shared Use**  Note: This section primarily addresses shared use, which is when the school shares the same facility with one or more other schools or organizations. . **S2.3.q 1**  **Does the school share its f acility with another group (co**  **- location, shared use)?**  **[If NO, skip to S2.3.q**  **1 4** **]** Yes No Please select the types of groups the school shares its facility with
. (Please select all that apply
. ) **S2.3.q 2.1**  Another public charter school **S2.3.q 2.2**  A public school that is not a charter **S2.3.q 2.3**  An organization (e.g., a church, non

- profit group) that provides services to students or the school **S2.3.q 2.4**  An organization (e.g., a church, non

- profit group) that does not provide services to students or the school **S2.3.q 2.5**  Other, please specify **S2.3.q2a Narrative explanation of S2.3.q2**  **– response 5**  **S2.3.q 4**  **How many schools , including yours,**  **share this facility? Note: answer ‘1’ if this is the only school that uses the** 

**facility.** 1. 1 2. 2 3. 3 4. 4 5. 5 6. 5+ **S2.3.q 5**  **What is the school’s current understanding (based on a written agreement or conversation with the landlord**  **) about**

**how long**  **it may remain in the facility?** 1. Through the end of the 201 4
- 201 5 school year5

2. For one additional school year (the end of the 2015

- 2016 school year) 3. Two more school years (the end of the 2016

- 2017 school year) 4. Three more school years (the end of the 2017

- 2018 school year) 5. Four more s chool years (the end of the 2018

- 2019 school year) 6. Five more school years (the end of the 2019

- 2020 school year) 7. More than five school years 8. Indefinitely 9. Do not know

**S2.3.q 6**  **How long does the school plan to remain in a shared use facility?**

1. Through the end of the 201 4
- 201 5 school year 2. For one additional school year (the end of the 2015

- 2016 school year) 3. Two more school years (the end of the 2016

- 2017 school year) 4. Three more school years (the end of the 2017

- 2018 school year) 5. Four more s chool years (the end of the 2018

- 2019 school year) 6. Five more school years (the end of the 2019

- 2020 school year) 7. More than five school years 8. Indefinitely 9. Do not know Please select the response that most accurately describes the extent to which you agree or disagree with the following statements: Strongly Disagree Disagree Agree Strongly Agree NA – This is the only school in this facility **S2.3.q 7**  **a Students from other co**  **- located schools have a negative impact on the school’s**  **climate and /or discipline.**  **S2.3.q 7b**  **Administrative/systems issues (e.g., PA announcements, bell schedules) from other co -**  **located schools have a**

**negative impact on the school’s climate and/or discipline.**  **S2.3.q 7c**  **Adults from other co -**  **located schools have a negative impact on the school’s climate and/or discipline** What are the school’s greatest concerns about co

-location (shared use)? ( Check all that apply .) **S2.3.q 8.1**  **Implementing the school’s curriculum/educational program given the amount of exclusive space that it has been**

**allocated S2.3.q**  **8.2 Implementing the school’s curriculum/educational program given the amount of time (or time of day) that it has** 

**b een allocated use of shared space**  **S2.3.q 8.3**  **Keeping students safe in the facility S2.3.q**  **8.4 Keeping students safe on the school grounds**  **S2.3.q 8.5**  **Maintaining a school climate consistent with the school’s mission and that is conducive to learning S2.3.q**  **8. 6**  **The uncertainty about whether or not the school will be able to remain in the facility S2.3.q**  **8.7 The quality of the building** **- wide staff that are shared**  **S2.3.q 8.8**  **Supervision of and/or interaction with the shared staff S2.3.q**  **8.11 Difficulty getting**  **maintenance and repairs completed in a timely manner S2.3.q**  **8.12 Lack of adequate parking (for parents, staff, and/or visitors) and/or lack of adequate pick** **- up and drop**  **- off areas**  **S2.3.q 8.13**  **Time spent converting classrooms and other teaching spaces to other uses**  **S2.3.q 8.14**  **Inability to schedule after -**  **hours school programs S2.3.q8.15**  **Inadequate broadband capability due to shared use. S2.3.q**  **8. 16**  **Other S2.3.q**  **8. 17**  **No significant concerns** What are the greatest benefits of co

-location (shared use) for the school? (Check all that apply)6 **S2.3.q 9.1**  **Eliminates or reduces facility expenses from what they would be otherwise S2.3.q**  **9.2 Provides opportunities for faculty/administration from different schools to learn from each o** **ther S2.3.q**  **9.3 Provides opportunities for students from different schools to learn from each other**  **S2.3.q 9.4**  **Facility’s amenities (gym, lunchroom, science labs, accessibility to individuals with disabilities, etc.) cannot feasibly**

**be duplicated in a space that the school could afford to own or rent**  **S2.3.q 9.5**  **Makes it possible to phase in grades or grow enrollment over time S2.3.q**  **9.6 Vacant space that would meet the school’s facility needs is not available in the neighborhoods that the school serves**  **S2.3.q 9.**  **7 Vacant space that would meet the school’s facility needs at a cost that the school could afford to rent or own is not** 

**available in the neighborhoods that the school serves S2.3.q**  **9.8 Eliminates the need to focus on facility related issues like maintenance**  **and repairs S2.3.q**  **9.9 Other**  **S2.3.q 9.10**  **No significant benefits** Please describe the extent to which you agree or disagree that the school has equitable access (including number of hours and times of day) to the following **[Skip to S3.1.q1 when done] :** 

Strongly Disagree Disagree Agree Strongly Agree Not Applicable **S2.3.q 10** **a G**  **ym S2.3.q**  **10 b**  **L unchroom**  **S2.3.q 10** **c A** **thletic / Play F**  **ields S2.3.q**  **10 d**  **P laygrounds**  **S2.3.q 10** **e General**  **Classrooms S2.3.q**  **10 f**  **S pecialized**  **C lassrooms**  **(e.g., science labs, computer labs,**  **art rooms) S2.3.q**  **10 g**  **L ibrary**  **S2.3.q 14**  **How long does the school plan to remain in this facility?**

1. Through the end of the 201 4
- 201 5 school year 2. For one additional school year (the end of the 2015

- 2016 school year) 3. Two more school years (the end of the 2016

- 2017 school year) 4. Three more school years (the end of the 2017

- 2018 school year) 5. Four more s chool years (the end of the 2018

- 2019 school year) 6. Five more school years (the end of the 2019

- 2020 school year) 7. More than five school years 8. I ndefinitely 9. Do not know


### Section 3 **– Site and Facility Amenities**  **S ection 3.1**  **– Site Amenities**  **S3.1.q 1**  **Does the school facility**  **have its own playground?**

1. Yes **[Skip to S3.1.q.3 if selected]** 2. No **[Skip to S3.1.q.4 if selected]** 3. No, but there is a local/adjacent park with a playground that we use for this purpose. 4. N/A the school only serves high school students **S3.1.q 2**  **[For schools answering choice 3 to question Q1]** Check the ways, from the following options, in which the local/adjacent playground meets the students' needs. **S3.1.q2.1 Size is adequate** 7 **S3.1.q2.2 Number of hours per week of availability is sufficient**  **S3.1.q2.3 Times of availability are convenient**  **S3.1.q2.4 None of the above are true**  **S3.1.q 3**  **Is there a separate playground for the early childhood and kindergarten students?**  Yes No

**S3.1.q4 Does the school facility have its own play/athletic field(s)?** 

1. Yes **[Skip to S3.1.q.6 if selected]** 2. No **[Skip to S3.1.q.8 if selected]** 3. No, but there is a local/adjacent park with an adequate athletic field that we use for this purpose. **S3.1.q 5**  **[For schools answering choice 3 to question Q 4** **]** Check the ways, from the following options, in which the local/adjacent playground meets the students' needs. **S3.1.q5.1 Size is adequate**  **S3.1.q5.2 Number of hours per week of availability is sufficient**  **S3.1.q5.3 Times of availability are convenient**  **S3.1.q5.4 None of the above are true**  **S3.1.q 6**  **Is the play/athletic field for student use natur al grass or artificial turf (schools with dirt, gravel or similar field**  **surfaces should answer ‘no’)?** Yes No **S3.1.q 7**  **Is the play**  **field large enou gh for normal school activities?**  Yes No **S3.1.q 8**  **Does the site have a perimeter fence?** Yes No



### Section **3.2 –**  **Physical Education S3.2.q1**  **Does the school facility have its own gymnasium (or its equivalent, dedicated space outside)?**

1. Yes **[Skip to S3.2.q.3 if selected]** 2. No **[Skip to S3.2.q.5 if selected]** 3. No, but there is a local/adjacent facility with a gym that the school uses for this purpose **[For schools answering choice 3 to question Q1]** Check the ways, from the following options, in which the local/adjacent gym meets the students' needs. **S3.2.q2.1 Size is adequate** 8 **S3.2.q2.2 Number of hours per week of availability is sufficient**  **S3.2.q2.3 Times of availability are convenient**  **S3.2.q2.4 None of the above are true**  **S3.2.q 3**  **Was the gym designed to be a physical education space?** Yes No

**S3.2.q 4**  **Are there locker rooms and/or shower facilities associated with the gym (i.e., in close proximity) for student use?**  Yes No **S3.2q5 From the items below, please indicate the amenities that students from the school must cross the street to access** 

**(select all that apply). S3.2.q5.1**  **Playground S3.2.q5.**  **2 Athletic/play field**  **S3.2.q5. 3**  **Gymnasium S3.2.q5.**  **4 Other**  **S3.2.q5. 5**  **None of the above S3.2.q**  **5 a**  **If other ,**  **please specify** 



### Section 3.3 **– Lunch**  **Service S3.3.q1**  **Does the school have a full preparatory food kitchen that meets the**  **requirements to prepare hot meals under the**  **federally subsidized meal program ?**  Yes No **S3.3.q 2**  **Does the school have dedicated space and equipment for keeping food for students warm (that typically has been**  **prepared at another location)?** Yes No **S3.3.q 3**  **Does the school have dedicated space and equipment for keeping food for students cold (that typically has been prepared at another location)?**  Yes No **S3.3.q5 Does the school have**  **lunches brought in by an outside vendor or caterer, including a school district? [**  **If NO, SKIP to**

**3.3.q4]** Yes No

**S3.3.q6 What is the**  **regular, unsubsidized price for**  **the student** **s’ lunches?**  **( Note, If grade levels pay different prices for lunch,**  **please provide the average**  **.)**9 **S3.3 .q4**  **Does the school participate in the National School Lunch Program?** Yes No



### Section 4 **- District Land and Facilities**  **Section 4.1 –**  **Use of District Owned Facilities S** **4.1 .q**  **1 Does the school currently**  **use a district owned facility?** Yes No **S 4.1**  **.q 2**  **To the best of your knowledge, is there a vacant district owned facility near the school? [SKIP to S4.2_1 if responded**  **NO]** Yes No **S4.1.q6 Would**  **the school consider relocating to the vacant district facility if the district offered the option?**  Yes No **S4.1.q 3**  **Has the school ever approached the district about use of its vacant facility? [SKIP to S4.2_1 if responded NO]**  Yes No **S 4.1**  **.q 4**  **Was the school offered use of the district’s vacant facility** **? [If YES, skip to S4.2_1]**  Yes No **S 4.1**  **.q 5**  **What explanation was given for denying the schoo l use of the district's vacant**  **facility?** 1. The district said it had plans for future use or possible use as a school. 2. The district said it had plans for future use or possible use as a support facility (storage, office space, etc.). 3. The district gave another explanation , please provide information on this explanation
. 4. The district gave no explanation.



### Section 4 **.2 –**  **Use of District Owned Land S4.2.q1**  **Does the school currently h ave use of district owned land?**  Yes No **S4.2.q 2**  **To the best of your knowledge is there unused district owned land near the school? [SKIP to S4.3_1 if responded NO]** 10 Yes No **S4.2.q 3**  **Has the school ever approached the district about use of its unused land? [SKIP to S4.3_1 if responded NO]**  **Yes No**  **S4.2.q 4**  **Was the school offered use of the district’s unused land? [SKIP to S4.3_1 if responded YES]**  Yes No

**S4.2.q 5**  **What explanation was given for denying the school use of the district's unused land?** 1. The district said it had plans to for future use or possible use as a school site 2. The district said it had plans for future use or possible use as a support facility site (storage, office space, etc.). 3. The district gave another explanation , please provide information on this explanation 4. The district gave no explanation.


### Section 4.3 **– Underutilized District Facilities**  **S4.3.q 1**  **To the best of**  **your knowledge, is there a district owned facility near the school that is significantly underutilized**  **( i.e.,**  **30 percent or more unused capacity)? [SKIP to Section 5 i** **f responded NO]**  Yes No **S4.3.q2 Would the school consider co** **- location in the underutilized district**  **school if the district offered the option?** Yes No

**S4.3 .q**  **3 Has the school ever approached the**  **district about use of its underutilized facility?**  **[SKIP to Section 5 if responded**  **NO]** Yes No **S 4.3**  **.q 4**  **Was the school offe red use of the district’s**  **underutilized facility?**  **[If YES, skip to Section 5, if responded NO]** Yes No **S 4.3**  **.q 5**  **What explanation was given for denying the schoo l use of the district's underutilized**  **facility?** 1. The district said it had plans for future use or possible use as a school. 2. The district said it had plans for future use or possible use as a support facility (storage, office space, etc.). 3. The district gave another explanation , please provide information on this explanation
. 4. The district gave no explanation. 

### Section 5 **– Site and Facility Characteristics**  **S ection**  **5 .1**  **– School Site** 11 Please select the response that most accurately describes the extent to which you agree with the following statement s regarding the school's site : Strongly Disagree Disagree Agree Strongly Agree Not Applicable **S5.1.q 1**  **The roof leaks rarely, if ever. S5.1.q**  **2 The site does not exhibit regular drainage problems such as standing water.**  **S5.1.q 3**  **The site shows no signs of apparent erosion. S5.1.q**  **4 Sidewalks are adequately located and sized**  **for student safety. S5.1.q**  **5 The site is adequately lighted.**  **S5.1.q 6**  **The parking lot is adequately lighted. S5.1.q**  **7 The site is free of hazards**  **like large cracks in the pavement**  **or sidewalks**  **and uneven ground.**  

### Section 5.2 **– Windows and Lighting**  Please indicate the extent to which you agree with the following statements regarding the school's windows and lighting:

Strongly Disagree Disagree Agree Strongly Agree **S5.2.q 1**  **Most classrooms/instructional spaces have enough natural day -**  **lighting, sufficient to occasionally turn off electric** 

**lights. S5.2.q**  **2 Most classrooms/instructional spaces have windows permitting views of the outside.**  **S5.2.q 3**  **Most classrooms/instructional spaces have windows that operate (open and close). S5.2.q**  **4 Most of the**  **school's windows have insulated glass (thermal pane). S5.2.q**  **5 Electric lighting is adequate for a major**  **ity of the school's activities.** 

### Section **5 .3**  **– Noise**  Please select the response that describes the extent to which you agree with each of the following :

Strongly Disagree Disagree Agree Strongly Agree **S5.3.q 1**  **Noise generated by the building mechanical systems (e.g., furnace, air conditioner, etc.) is disruptive in the** 

**classrooms .**  **S5.3.q 2**  **Exterior noise intrusion (e.g., traffic, trains, aircraft,**  **and industry** **) is disruptive in the classrooms .**  **S5.3.q 3**  **Noise generated from other classrooms or corridors is disruptive in the classrooms**  **. S5.3.q4**  **Noise generated by the building**  **mechanical systems (e.g., furnace, air conditioner, etc.) can be heard**

**inside the specialized instructional spaces (e.g.**  **, library, computer**  **lab, science lab, music room, etc.**  **) and learning is significantly impacted.**  **S5.3.q 5**  **Noise from the g** **ym, a**  **uditorium, or l**  **unchroom impact s**  **learning in classrooms. S5.3.q**  **6 Noise from the specializ**  **ed instructional spaces (e.g.**  **, library, computer lab, science lab, music room,**  **etc. ) impact**  **s**

**learning in other**  **classrooms .**  

### Section **5 .4**  **– Air Quality**  Please answer the following questions regarding the school's air quality: Yes No **S5.4.q 1**  **Has the school experienced air quality problems due to mold or mildew?**  **S5.4.q 2**  **Is the air quality in the majority of classrooms good? S5.4.q**  **3 Is the air quality throughout**  **the rest of the facility good?** 

### Section **5 .5**  **– Mechanical and Electrical** 12 Please respond to the following statements regarding the general temperature in the school:

Strongly Disagree Disagree Agree Strongly Agree **S5.5.q 1**  **The temperature in the classrooms is reasonably comfortable throughout the school year .**  **S5.5.q 2**  **The temperature throughout the building is reasonably comfortable throughout the school year**  **. S5.5.q**  **3 Most classrooms are air conditioned**  **.**
Please indicate the extent to which you agree with the following statements:

Strongly Disagree Disagree Agree Strongly Agree **S5.5.q 4**  **Most classrooms have a telephone available for teacher use .**  **S5.5.q 5**  **Most classrooms have e lectrical power outlets adequate in number and location**  **for the majority of activities .**  

### Section **5 .**  **6 –**  **Plumbing and Fixtures** Please select the response that describes the extent to which you agree with each of the following:

Strongly Disagree Disagree Agree Strongly Agree **S5.6.q 1**  **The water pressure inside the facility is adequate. S5.6.q**  **2 The quantity of student toilet rooms is adequate.**  **S5.6.q 3**  **The student toilet rooms are well**  **- located.**  **S5.6.q 4**  **The quantity of adult toilet rooms is adequate. S5.6.q**  **5 The adult toilet rooms are well**  **- located.**  **S5.6.q 6**  **The quantity of drinking fountains is adequate. S5.6.q**  **7 The drinking fountains are well**  **- located.**  

### Section 5.7**– Facility Security**  Please indicate which of the following security items the school has installed in the school’s facility: Yes No **S5.7.q1 A functioning two**  **- way communication system between the administration office and the rest of the**  **facility S5.7.q2**  **A functioning two -** **way communication system between the administration office and the exterior of the building S5.7.q3**  **A functioning controlled access system at the main entrance of the facility that is used during school hours S5.7.q4**  **Func tioning locks on all exterior facing doors in the facility**  **S5.7.q5 Functioning locks on all classroom doors that can be locked from both the inside and outside of the classroom**  **S5.7.q6 A functioning interior video surveillance system**  **S5.7.q7 A functioning**  **exterior surveillance system S**  **5.7.q8 An other fixed security device**  **S 5.7.q8b**  **Other described** 

### Section 5. **8 –**  **Technology Please select the way** **(s) that students in the school a**  **ccess technology while during school hours . (Select all that apply.)** 13 **S5.8.q1 Computer lab(s) space**  **S5.8.q2 Mobile computer lab(s)**  **S5.8.q3 Individual student laptops/tablets**  **S5.8.q4 Computer(s) in every classroom**  **S5.8.q5 Other**  **S5.8.q5b Describe other**  **S5.8q6 Are there any facility challenges that prevent the installation of**  **sufficient broadband to access high quality digital content?**  Yes No 

### Section 6 **– Facility**  **Funding and Expenditure**  **s Section 6.1**  **– Capital Projects**  Note: In this section you will be asked for dollars amounts. Please enter whole numbers rounded to the nearest dollar

-- no dollar signs, decimal points or commas. **S6.1.q 1**  **Has the school facility undergone , or will it**  **undergo, any major capital projects between July**  **1, 200 8** **, and June 30,**

**201 3**  **? [Skip to S6.**  **1 .q4**  **if NO]** Yes No What types of capital project(s) has the facility undergone , or will it undergo

, in this five year period

______ through

_______)? [Check all applicable] **S6.1.q 2a**  **Purchased land and/or a facility S6.1.q**  **2b Constructed a facility**  **S6.1.q 2c**  **Constructed an addition to an existing facility**  **S6.1.q 2d**  **Renovated or upgraded a n**  **existing facility S6.1.q**  **2e Undertaken major facility repairs**  **S6.1.q 2f**  **Other S6.1.q2g**  **Narrative explanation if S6.1.q2f checked** Please list the amount of funding (enter whole numbers only
– no dollar signs, decimal points or commas) from each of the following sources and the total amount spent on capital projects during this five year period (7/1/2011 through 6/30/201 5). For schoo ls with expenditures on capital projects in 2014
-2015 , include the estimate of the dollars that will be spent by the end of the school year. Note: the sum of the funds from each source should be equal to the total amount spent over the five year period**. S6.1.q**  **3a Cash from school district (other than bond dollars)**  **S6.1.q 3b**  **School per pupil grant (**  **if such program exists in the state) and reserve funds generated from**  **grant program S6.1.q**  **3c Gifts and fundraising**  **S6.1.q 3d**  **Local tax revenue (e.g., district bonds, sales or property tax) S6.1.q**  **3e Bond(s) and/or loan(s)** **, including bonds issued by the school district**  **or the**  **State Bond Program S6.1.q2g**  **Other S6.1.q2h**  **Narrative explanation of other S6.1.q3f**  **Total spent over the last five years on capital projects (should equal the sum of a**  **- e above)**  **S6.1.q 4**  **Is the school currently (in 2014** **- 2015**  **) saving money from state grant program**  **to create a reserve for any of the**  **following?** Note: answer NO if the dollars being saved are a bond program reserve requirement for capital replacement or repair. Do not include dollars that will be spent in 2014
-2015

1. Yes, for the purchase of an existing facility (current facility or other)14

2. Yes, for the renovation of the current facility 3. Yes, for the construction of a new facility 4. No, not currently saving from state grant program [ **Skip To S6.2_1, If Selected] S6.1.q**  **4b Please estimate the amount that will**  **be saved**  **in the**  **2014 -**  **2015 school year.**  

### Section **6 .2**  **– Bond and Loan Information**  **S6.2.q 1**  **Does the school have bond or loan expenditure s**  **for the current land and/or facility? [SKIP to S6.3_1 if NO]**  Yes No **S6.2.q 2**  **What will be**  **the total annual principal and interest payment fo r the**  **bonds and/or loans**  **in 2014** **- 201**  **5 ?**  **S6.2.q5 What was the amount of the bond or loan at the time at the time of origination?**  **S6.2.q6 What is the interest rate on the bond or loan?**  **(Numbers to one decimal place only, no percent sign; for example, 6.7).**  **S6.2.q7 What was the length of the loan at the time when it was originated? (**  **Whole numbers only) S6.2.q**  **3 Does the school have a required reserve for capital replacement or repair**  **? [**  **SKIP to S**  **6.3 .q**  **1 if answered NO]** Yes No **S6.2.q 4**  **How much will**  **the school pay into this reserve account in**  **2014 -**  **2015 ?**  ( W hole numbers only) **S6.2.q8 How many financing options did the school consider before deciding on the bond/loan described above?** 


### Section **6 .3**  **– Rental Information**  Note: for the questions below, use whole numbers only. A lso, please do not include dollar signs, commas, or decimal points. **S6.3.q 1**  **Does the school currently pay**  **for the school's land or facility? [SKIP to**  **S 6.**  **4 .q1**  **if answered NO]** Yes No **S6.3.q 2**  **What is the**  **total payment**  **the school will make for the facility or land in**  **2014 -**  **2015 ?** 
Please check all items that are included in the payment : **S6.3.q 3a**  **Gas /fuel oil/propane**  **S6.3.q 3b**  **Electricity S6.3.q**  **3c Water**  **S6.3.q 3d**  **Sewage S6.3.q**  **3e Custodial**  **s ervices**  **S6.3.q3i Building maintenance and**  **upkeep (i.e., structural maintenance) S6.3.q3j**  **Site maintenance (i.e., trash removal, yard maintenance) S6.3.q**  **3 f**  **None of the above S6.3.q**  **3 g**  **Other , please specify**  **and briefly describe the purpose of the payment S6.3.q**  **3h Narrative explanation of S6.3.q3g** 15 **S6.3.q 4** 

**. Does the school make any payments to the owner other than rent (**  **including facility assessments paid to the district**  **)?** Note, do not include authorizer administration fees if authorized by the local school board. **[SKIP TO S6.4 .q**  **1 IF NO]** Yes No **S6.3.q 4b**  **If yes, please provide the total**  **payment for**  **2014 -**  **2015 .**  **S6.3.q 4c**  **If yes, briefly describe the purpose of the payment .**  **S6.3.q 5**  **Does the school have a written lease agreement with the landlord (or district)?**  Note: schools that own their own facility should answer NA **. [SKIP TO S2.2.q1, if NO or NA]**  Yes No NA – the school owns the facility
**S6.3.q6 What is the length of the current lease agreement? (Round to the nearest number of years, whole numbers only;**  **for example, ‘3’ if the lease is for a three**  **- year period; ‘4’ if the lease is for3 and one**  **- half years.)**  **S6.3.q7 Does the school make payments for the use of an off** **- site gym and/or athletic facility?**  Yes No

**S6.3.q8 What is the annual rental payment**  **for the school’s use of a gym and/or athletic field at another location (if the school does not rent a separate gym and/or athletic field, enter zero.)?**  **S6.3.q9 What are the annual costs for transporting students to and from the gym and/or athletic field**  **at another location (if the school does not pay for transportation or transport students, enter zero.)?** 



### Section 7 **– Access to Special, State and Local Sources of Facility Funding**  **Section 7.1 –**  **Local Funding Sources S7.1.q**  **1 Has the authorizing**  **district had a general obligation bond election for facilities since July 1, 2006, or since the charter school opened, whichever is later?**  **[SKIP to S7.2_Q1 if NO]** Yes No Please answer the following questions regarding the school's participation in district bond elections. Yes No N/A **S7.1.q 2a**  **Has the authorizing school district ever given the school notice of a future bond election? [SKIP to 2c if NO]**  **S7.1.q 2b**  **Was the notice in time for the school to submit a request for inclusion on the bond? S7.1.q**  **2c Has the school ever been invited by the district to participate in a district bond election?**  **S7.1.q 2d**  **Has the school ever requested that it be included in a district bond election? S7.1.q**  **2e Did the district deny or discourage the school from being**  **included?**16 **S7.1.q 3**  **Since July 1, 2006, has the authorizing district included funding for the school in a district bond election intended to fund facility projects?**  **[SKIP to S7.2_1 if NO]** Yes No Complete the following set of questions for each bond initiative for facilities since July 1, 2006. In the web version, additional bond initiatives are added by clicking on the “ Click to add another bond” button. **S7.1.q 4a**  **In what year was the election held? S7.1.q**  **4b What school district held the election?**  **S7.1.q 4c**  **What was the total amount requested?** (Round to the nearest dollar

- whole numbers only) **S7.1.q 4d**  **What amount was designated for the charter school? S7.1.q**  **4e D**  **id the ballot measure pass? S7.1.q**  **4f Did the school experience any difficulty accessing its bond allocation?**  **[Applicable only if S7.1.q 4** **e is YES]** 

### Section 7.2 **– State Facilities Grants**  **S7.2.q1 Since July 1, 2006,**  **has the school ever submitted an application to [THE STATE] Department of Education for a STATE**  **FACILITIES GRANT? [Skip to 3a if YES; go to 2a if NO]**  Yes No Please select all applicable reasons why the school has not applied for a STATE FACILITIES GRANT since July 1, 2006. **S7.2.q 2a**  **The school does not have capital construction needs qualified for support from the grant program. S7.2.q**  **2b The school does not have capital construction needs.**  **S7.2.q 2c**  **The application process was too cumbersome or confusing. S7.2.q**  **2d Lack of success of o** **ther charter schools discouraged us from applying. S7.2.q**  **2e The school could not obtain the required matching funds.**  **S7.2.q 2f**  **The size of the typical award amount does not warrant the effort required to complete an application. S7.2.q**  **2g The school was**  **unaware of the grant program. S7.2.q**  **2h Other**  Please describe each of the state grant applications that the school has submitted since July 1, 2006, whether awarded or not
. In the web version, additional bond initiatives are added by clicking on the “Click to add another bond” button. **S7.2.q 3a**  **Year applied S7.2.q3b**  **Amount requested S7.2.q3c**  **Amount awarded**

This ends your portion of the STATE Charter School Facilities Survey. Thank you for your participation. This information will be used to create a charter school facilities database that identifies prominent strengths and shortcomings in multiple states’ facility landscapes and provides valid data for analysis that will enable states to develop policy responses. If you have not already been con tacted by the STATE CSO to make an appointment to come measure your school’s facility, please contact CSO CONTACT immediately. If you have been contacted and have not yet set a time, please do so immediately. A final report outlining the results of the S TATE charter school facilities survey will be available in ANITICIPATED MONTH. Thank you! CSO PRESIDENT17 

### Section 8 **– Total Facility and Site Measurements**  **Note: All questions in**  **S ection 8 should be answered based on the**  **2014 -** **2015 school year.**  

### Section 8.1 **- Facility and Site Size**  **S8.1.q1 How large is the facility in square feet (total square feet including modular classrooms)?**  **S8.1.q 2**  **How large is the school site** **, in acres**  ( space that is exclusively for the school’s use) **?** 1 acre = 43,560 sq. feet, so to get acres from square feet, divide the square footage by 43,560
. Enter up to one decimal place. Note: the site measurement includes the facility footprint. However, if the school does not have any dedicated outdoor area, please enter 0. **S8.1 .q**  **3 Does this facility rely upon exterior**  **(outside) space to connect different buildings serving a single population of**  **students ?**  **[ S**  **kip to S** **9.1_1 if NO**  **]** Yes No **S8.1.q 4**  **W hat percentage of the exterior walkways are covered**  **?** 1. 0
- 25% 2. 26
- 50% 3. 51
- 75% 4. 76
- 100% 

### Section 9 **- Classroom Summary**  **Section 9.1 -**  **General Classroom Summary (enter whole numbers only) S9.1.q1**  **How many early childhood education and or k**  **indergarten classrooms does the school have? S9.1.q**  **2 How many elementary classrooms (grades 1**  **- 5) does the school have?**  **S9.1.q 3**  **How many middle school classrooms (grades 6 -** **8) does the school have? S9.1.q**  **4 How many high school classrooms (grades 9**  **- 12) does the school have?**  

### Section 9.2 **– Specialized Learnin**  **g Spaces Summary (enter whole numbers only) S9.2.q**  **1 How many libraries/media centers does the school have?**  **S9.2.q 2**  **How many computer labs does the school have? S9.2.q**  **3 Does the school have a mobile computer lab(s) in addition to, or instead of, a**  **classroom lab(s)?** Yes No **S9.2.q 4**  **How many science labs does the school have? S9.2.q**  **5 How many art rooms does the school have?**  **S9.2.q 6**  **How many music rooms does the school have? S9.2.q**  **7 How many special education recourse rooms does the school have?**  **S9.2.q 8**  **How many gyms, auditoriums, and lunchrooms does the school have? S9.2.q**  **9 How many health clinics does the school have?**  

### Section 10 **- Classroom**  **Measurements**18 Note: All questions in Section 9 should be answered based on the 2012
-2013 school year. This section should be completed by the school’s facility survey contractor. T he number of classrooms entered must match the number reported in the section above. 

### Section 10.1 **- Pre**  **- K and/or Kindergarten Classrooms**  Please describe all Pre

-K and Kinderg arten Classrooms in this section by answering the questions below for each classroom or group of classrooms
. In the web version, additional classrooms are added by clicking on the “Add a Pre
-k and/or Kindergarten Classroom” button. **S10.q1 # of**  **rooms fitting this description**  **S10.q2 Maximum # of students (at one time)**  **S10.q3 Square footage**  **S10.q4 Is thi**  **s a modular room (trailer) ?**  **Yes/No S1**  **0 .q**  **5 Is there a b**  **athroom inside the class**  **ro om**  **? Yes/No**  **S10. q6**  **Is there a w o**  **rking sink inside the class**  **room ?**  **Yes/No S10.q**  **7 Is there a p**  **ermanently mounted LCD projector and projecting surface?**  **Yes/No S10**  **.q8 Are Pre**  **- K students served in this classroom? Yes/No**  

### Section 10. **2 -**  **Elementary Classrooms (Grades 1 -**  **5)** Please describe all elementary classrooms (Grades 1

-5) in this section by answering the questions below for each classroom or group of classrooms. In the web version, additional classrooms are added by clicking on the “Add an Elementary School Classroom” button. S10.q1 # of rooms fitting this description **S10 .q2**  **Maximum # of students (at one time) S10.q3**  **Square footage S10.q4**  **Is this a modular room (trailer)? Y** **es/No S10.q**  **6 Is there a w** **orking sink inside the classroom? Yes/No**  **S1 0**  **.q 7**  **Is there a p ermanently mounted**  **LCD projector and projecting surface? Yes/No** 



### Section 10. **3 -**  **Middle School Classrooms (Grades 6 -** **8)** Please describe all middle school classrooms (Grades 6

-8) in this section by answering the questions below for each classroom or group of classrooms. In the web version, additional classrooms are added by clicking on the “Add a Middle School Classroom”. **S10.q1 # of rooms fitting this description**  **S10.q2 Maximum # of students (at one time)**  **S10.q3 Square footage**  **S10.q4 Is this a modular room (trailer)?**  **Y es/No**  **S10.q7 Is there a p**  **ermanently mounted LCD projector and projecting surface?**  **Yes/No** 

### Section **10 .4**  **– High School Classrooms (Grades 9** **- 12)**  Please describe all high school classrooms (Grades 9

- 12) in this section by answering the questions below for each classroom or group of classrooms. In the web version, additional classrooms are added by clicking on the “Add a High School Classroom”. **S10.q1 # of rooms fitting this description**  **S10.q2 Maximum # of students (at**  **one time) S10.q3**  **Square footage S10.q4**  **Is this a modular room (trailer)? Y** **es/No S10.q7**  **Is there a permanently mounted LCD projector and projecting surface? Y** **es/No**19 

### Section 11 **- S**  **pecialized Learning**  **Spaces Section 11.1**  **-** 

### Library/Media Center Please describe all the school’s library/ m edia Center spaces in this section by answering the questions below for each library/media center or group of centers. In the web version, additional library/media centers are added by clicking on the “Add New Library / Media Center” button. **S11.q1 Number of rooms fitting this description**  **S11.q2 Maximum #**  **o f students (at one time)**  **S11.q3 Square footage**  **S11.q4 L** **owest grade level served S11.q5**  **Hi ghest grade level served**  **S11.q6 Is thi**  **s a modular room (trailer) ?**  **Yes/No S11.1.q1**  **Is there a reading/ i**  **nstructional a**  **rea ?**  **Yes/No S11.1.q2**  **Is there a r eference/**  **i ndependent**  **s tudy**  **a rea**  **? Yes/No**  **S11.1.q3 Is there an office/workspace for the librarian?**  **Yes/No S11.1.q4**  **Is there a c ompu**  **ter/ o**  **nline r** **eference a**  **rea ?**  **Yes/No** 

### Section 11.3 **-** 

### Science Labs Please describe all the school’s science labs in this section by answering the questions below for each science lab or group of labs. In the web version, additional science labs are added by clicking on the “Add New Science Lab” button. **S11.q1 Number of rooms fitting this description**  **S11.q2 Maximum # of students (at one time)**  **S11.q3 Square footage**  **S11.q4 Lowest grade level served**  **S11.q5 Highest grade level served**  **S11.q6 Is this a modular room (trailer)?**  **Y es/No**  **S11. 3**  **.q1 Is th**  **ere a separate storage area for chemicals? Y** **es/No S11.**  **3 .q2**  **Is there a separate prep room**  **(to prepar** **e demonstrations or lab assignments**  **) ?**  **Yes/No S11.**  **3 .q3**  **I s there a gas connection?**  **Yes/No S11.**  **3 .q4**  **Is there a built -**  **in fume hood? Y** **es/No S11.**  **3 .q5**  **I s**  **biology or chemistry taught in this room? Yes/No**  

### Section 11.4 **-** 

### Art **R ooms**  Please describe all the school’s art rooms in this section by answering the questions below for art room or group of rooms. In the web version, additional rooms are added by clicking on the “Add New Art Rooms” button. **S11.q1 Number of rooms fitting this description**  **S11.q2 Maximum # of students (at one time)**  **S11.q3 Square footage**  **S11.q4 Lowest grade level served**  **S11.q5 Highest grade level served**  **S11.q6 Is this a modular room (** **trailer)? Y** **es/No S11.q**  **7 Is there a f** **un ctioning**  **s ink (with**  **w ater)**  **? Yes/No**  **S11.q 8**  **Is there a s torage c**  **loset ?**  **Yes/No S11.**  **4 .q**  **1 Is there a functioning kiln?**  **Yes/No**20 

### Section 11.5 **- Music**  

### R**ooms** Please describe all the school’s music rooms in this section by answering the questions below for music room or group of rooms. In the web version, additional rooms are added by clicking on the “Add New Music Room” button. **S11.q1 Number of rooms fitting this description**  **S11.q2 Maximum # of students (at one**  **time) S11.q3**  **Square footage S11.q4**  **Lowest grade level served S11.q5**  **Highest grade level served S11.q6**  **Is this a modular room (trailer)? Y** **es/No S11.q**  **8 Is there a**  **storage cl**  **oset ?**  **Yes/No** 

### Section 11.6 **-** 

### Special Education Resource Rooms Please describe all the school’s special education resource rooms in this section by answering the questions below for each special education resource room or group of rooms. In the web version, additional rooms are added by clicking on the “Add Special Education Resource Room” button. **S11.q1 Number of rooms fitting this description**  **S11.q2 Maximum # of students (at one time)**  **S11.q3 Square footage**  **S11.q4 Lowest grade level served**  **S11.q5 Highest grade level served**  **S11.q6 Is this a modular room (trailer)?**  **Yes/No S11.q**  **7 Is there a**  **functioning s**  **ink (**  **with water )**  **? Yes/No**  **S11.6.q 1**  **Is there an a ccessible**  **b athroom**  **? Yes/No** 


### Section 11.7 **-** 

### Gym, Auditorium, and Lunchroom Please describe all the school’s gyms, auditoriums, and lunchrooms in this section by answering the questions below for each gym, auditorium, and lunchroom. In the web version, additional rooms are added by clicking on the “Add Gym, Auditorium, and Lunchroom” button. **S11.q2 Maximum # of students (at one time)**  **S11.q3 Square footage**  **S11.q4 L** **owest grade level served S11.q5**  **Highest grade level served S11.q6**  **Is this a modular room (trailer)? Y** **es/No S11.7.q1**  **Room use #1**

**Gym Auditorium (includes use for assemblies, plays, theater and rainy day room)**  **Lunchroom Other**  **S11.7.q2 Room use**  **#2**

**Gym Auditorium (includes use for assemblies, plays, theater and rainy day room)**  **Lunchroom Other**  **S11.7.q3 Room use #3** 

**Gym**21

**Auditorium (includes use for assemblies, plays, theater and rainy day room) Lunchroom**  **Other** 

### Section 11.8 **-** 

### Health Clinic Please describe all the school’s health clinics in this section by answering the questions below for each health clinic or group of clinics. In the web version, additional clinics are added by clicking on the “Add Health Clinic” button. **S11 .q2**  **Maximum # of students (at one time) S11.q3**  **Square footage S11.8.q1**  **Does the health clinic have a sink?**  **Yes/No S11.8.q2**  **Does the health clinic have a restroom? Yes/No**  

### Section 12 **- Decision Making Process for Facilities**  **S12.q1 In the space below,**  **please describe the school’s decision making process when selecting the current facility.**