The increased life span and the inclusion of children with special health care needs in the public school systems have caused a greater demand for health care provision in the classroom. A survey was created to assess the continuing education needs of public school nurses and prevalence of chronic conditions and health care procedures performed in Alabama’s public schools. The aim was to understand the complexity of caring for children with special health care needs and the demand for nursing services in public schools. A study of this type had not been published in Alabama. This instrument was developed by combining surveys previously utilized in other states. The survey was then validated by a panel of experts using a modified Delphi process. The survey was distributed to all AL school nurses via U.S. Mail. A second mailing to nonresponders and phone call follow-up increased the response rate. Four hundred and twenty-two surveys were returned by nurses in 1,481 schools representing a response rate of 28.49%. Juvenile diabetes was the most requested topic for continuing education followed by Asthma. The educational format most requested was an in-service format. A mean of 55.51 chronic conditions existed per public school in Alabama; the most prevalent chronic condition was asthma with a mean of 22.75 students with asthma per school. Approximately 22 nursing procedures were performed each day per school. Administering oral medication was the most commonly performed health care procedure with a mean of 6.26 procedures per day per school. When the data are extrapolated to represent the entire state school population and not just the 422 responding schools, 82,210 cases of chronic conditions would exist including 33,692 cases of asthma. More than 71,000 AL students require health care procedures each year, yielding 33,145 health care procedures performed daily. This study will assist in the creation of educational programs for school nurses and the care for this student population.