Submit Your Success Story
Information about your school
Name of School
Street
State West Virginia
City/Town
Zip
School Enrollment
Information about you:
Your First Name
Your Last Name
Your Job Title
Your Phone Number
Your Email Address
Confirm Email
Tell us about a specific success your school has achieved in their school environment. This success story
may be related to healthy eating, physical activity, safety, tobacco-free lifestyles, reproductive health or
another health topic.
Please complete this form for each separate success story and submit each separately. Do not combine
several success stories into one submission. There is no limit to the number of success stories your school
can submit and we encourage you to submit as many as you like.
Problem Overview:
1. Please briefly describe the main problem that you were faced with and tell why it was important to change.
Be sure to provide data to show support for the problem. Also, be certain to specify who was affected by the
issue at hand.
Program/Activity Description
2. Give a description of the activity or program. Include who was involved, where and when it took place, the
target audience of the program, and how the progress of the program was evaluated.
Program/Activity Outcomes:
3. Explain outcomes that proceeded the activity or program. Identify the short term, long term, or intermediate
outcomes that happened as a result of the program. In addition, provide a conclusion to the program as a whole.
For further assistance on how to develop a success story please visit the link below
http://www.cdc.gov/healthyYouth/stories/pdf/howto_create_success_story.pdf
If you have answered all the questions above, please read the information below before you
submit your success story.
By completing this form and clicking the button below to submit your success story, you are consenting to have your
school information and success story shared and published on this and other related websites and in other print and web
media used to motivate and mentor other schools working toward a healthy school environment.
By completing and submitting this form, you are also providing permission for us to contact you for further information or
clarification.
Not all success stories may be published. The WVDE-Office of Healthy Schools Success Story Team reserves the right
to selectively publish success stories.
Please double check the text of your success story text prior to clicking the button below to ensure it is free of typos or
other errors. You will not be able to change your success story after it is submitted. To review your success story, text
scroll up to #6 above, re-read your story and make any necessary edits. You may wish to write the story in a word
proccessor and paste it into the #6 textbox.
Attach any supplemental materials (photos, tools developed, etc.) with the submitted story.
If you have problems with submission, contact Linda Payne at (304) 558-8830-lfpayne@access.k12.wv.us
or Rick Deem at (866) 232-7372-rddeem@access.k12.wv.us
Click here to submit your success story by email
Click here to print story