SCHOOLS FOR HEALTHY LIFESTYLES
APPLICATION PACKET
NEW SCHOOLS
2014-15
Mac McCrory, Ed.D.
Executive Director
Mac@healthyschoolsok.org
Lindsi Lemons, MPH
Program Director
Lindsi@healthyschoolsok.org
Sherre James
Operations Director
Sherre@healthyschoolsok.org
500 N. Broadway, Suite 225
Oklahoma City, Oklahoma 73102
Phone: 405-606-8435
Fax: 405-606-8437
www.healthyschoolsok.org
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APPLICATION INSTRUCTIONS
1.
Review criteria and program requirements/grant spending guidelines (listed
below).
2.
Completed applications must be in the SHL office, 500 N. Broadway,
Suite 225, Oklahoma City, OK, 73102, by Thursday, February 27, 2014
by 4:00 p.m. (Located in the Gaylord Building next to downtown YMCA;
parking is available on southeast corner of 4th and Broadway.) Applications
delivered by mail or hand after the deadline will not be accepted.
Applications cannot be submitted by email or fax.
NOTE:
You will be notified prior to the end of this school year whether or not your
school has been selected.
CRITERIA
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Your school must be a public elementary school, grades K through 5/6. (Due to public
funding, private schools cannot be approved for participation.)
Faxed or emailed applications will NOT be accepted.
Only typed proposals, which meet application criteria, will be considered.
Please do not include extra attachments (photos, brochures, etc.)
Do not bind original application (paperclip is fine).
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Program Requirements/ Grant Spending Guidelines
1. This application process is for a three-year tiered program. After the third year, and if your
school meets all the requirements associated with each year, you will become a Senior/Certified
school and be eligible for programs available only to Senior schools.
2. If your school has more than 700 students, two coordinators must be selected.
3. If your elementary is located on more than one campus, you must have principal approval from
all campuses and each location must have a Coordinator.
4. Attendance of your team at the Summer Health Institute. Your school must select a threemember team to attend the Summer Health Institute. Your team must consist of the Coordinator
and/or the PE teacher. (If your school is located on more than one campus, PE teachers from all
campuses must attend.) The same three-member team from your school MUST attend all sessions
of the Summer Health Institute in order to receive the grant and participate in the SHL program.
Principals are strongly encouraged to attend all sessions of the workshop and can also be counted
as one of your team. Attendance will be monitored and participants will receive a certificate of
attendance for professional development credits.
5. Presentation of an SHL overview for your school staff. Each school will conduct the SHL
orientation at the beginning of the school year to inform other staff members about the SHL
program, available resources and curricula, their role in the project, etc. SHL staff is available to
give these presentations.
6. Schools will administer Fitnessgram physical fitness testing for 3rd through 6th graders (pretest in fall; post-test in spring). Necessary materials, equipment, training and forms will be
provided to perform and report the physical fitness testing. All five SHL required fitness tests
must be completed: mile run or pacer, push-ups, sit and reach, trunk lift, and curl ups. Schools
will input their own data by a specified deadline. In collaboration with the State Department of
Health, each school will receive testing equipment and training for test administration and data
entry.
7. A health knowledge, attitudes, and behaviors online survey will be administered twice per year
(pre-test in fall; post-test in spring). Grades to be tested will be decided at a later date. A parental
permission form for each student is required to participate in the written survey. Permission forms
must be given to the survey administrator to be returned to SHL. (Permission form will be
provided by SHL.)
8. SHL provided curriculum must be implemented in the year it is given (i.e., HealthTeacher in
first year, Risk Watch in second year, etc.) and in all subsequent years.
9. One activity or event (walking club, health fair, etc.) per semester is required. You might
want to center activities on national campaigns (ex. Heart-Health Month in February or Nutrition
Awareness Month in March).
10. Submit required Mid-Year and End of Year report by deadline. Schools will submit a MidYear Report in January and an End of Year Report listing program accomplishments. A copy of
all receipts for grant expenditures must be attached. Report forms will be provided by SHL.
11. If a deadline cannot be met, you must notify the SHL office within 5 business days to request a
time extension.
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12. Approved budget must include any items to be purchased including promotional items,
professional development, transportation, equipment, etc.
13. In general, grant funds can be spent for most equipment for PE classes, health curricula, and
other teaching resources such as visual aids, education videos, etc. SHL discourages the purchase
of consumable items unless being used for a nutrition lesson. During the first year in the SHL
program, grant funds must be spent on materials/supplies for the two focus areas you will
implement (physical activity and nutrition).
14. Promotion items (t-shirts, hats, etc.) may be budgeted for purchase with grant funds if used as an
incentive (weight loss or walking programs, etc.) for students or staff. A total of $100 per year
can be spent for promotional items.
15. Grants funds may be used to pay for appropriate professional development fees, or substitute fees
for coordinators only if: 1) a specific request has been outlined in the school’s budget or with
prior approval by SHL, and (2) the workshop/conference or special event directly relates to one of
SHL’s five focus areas. A school’s total professional development costs should not exceed $100
per coordinator.
16. Grant funds may be used for bus transportation to SHL sponsored events if:
(1) a specific request has been outlined in the school’s budget or by prior approval by SHL,
and
(2) the event directly relates to one of the five focus areas.
Not more than $200 can be spent for transportation costs per year.
16. Any changes to the approved budget must be submitted on Budget Change Request Form and
approved by SHL staff prior to expenditures. (Form can be found on the flash drive given to you
at the Summer Health Institute.)
17. In subsequent years, carryover funds cannot total more than $2,250. A specific plan must be
submitted and approved for projects that require more than $2,250.
18. All SHL schools must apply for the Certified Healthy Schools program through the Oklahoma
State Department of Health. SHL will send how-to information when available.
19. New requirements can be added at any time, and each school will be responsible for making
sure full compliance is met.
COMPLIANCE POLICIES
All non-compliance issues will be submitted to the Program Committee who will recommend
appropriate action to the Board of Directors.
1. If any of the above requirements cannot be met, you must notify SHL within 5 business days to
explain your situation. SHL has the right to place your school on probation or (depending on the
importance of the requirement) remove your school from the SHL program. (For example, a
requirement that may result in removal is refusal to implement testing.) A probation period
may last up to one year and may result in not being awarded the next year’s grant.
2. If your school is placed on more than 2 probationary periods during your participation in the SHL
program, it will result in immediate dismissal from the SHL program.
3. If your school should leave (for any reason) the SHL program before your school is a
senior/certified school, all equipment and unspent grant funds must be returned to SHL.
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4.
All SHL schools are subject to a site visit by SHL staff and/or Program Committee member
which will consist of an audit of equipment, finances, and use of SHL resources. If any
equipment or grant funds cannot be accounted for, this will be reported to the Program
Committee and your school will be responsible for replacing the missing equipment or funds.
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SCHOOLS FOR HEALTHY LIFESTYLES
PROGRAM OVERVIEW
1. Freshmen (Year 1) – Five schools will be admitted to the SHL program. Grant amount $1,000. These schools will implement two focus areas: Physical Activity and Nutrition.
Schools will receive:
 fitness testing equipment,
 Physical Activity/Nutrition curriculum, and
 Mileage Club materials.
2. Sophomore (Year 2) – Grant amount - $750. Two more focus area will be added:
Injury Prevention and Tobacco Use Prevention. Schools will receive:
 Injury Prevention materials;
 Tobacco Use Prevention materials;
In addition, each school will receive:
 Xbox Kinect;
 Fat and sugar lipos and food models to supplement the Nutrition focus area.
3. Junior (Year 3) – Grant amount - $500. One focus area will be added: Oral Health.
Schools will receive:
 Adopt-A-Dentist (if available) and dental health materials.
 Adopt-A-Doc (if available) will also be added in this year.
 Additional materials for all focus areas as determined by SHL staff.
If your school should leave the SHL program (for any reason) prior to becoming a
Senior/Certified school, all equipment and unspent grant funds must be returned to SHL.
4. Senior/Certified (Year 4+) - Grant amount – up to $500. (The grant award will be
based on specific needs and carry over amounts.) Certified Schools will be eligible for
SHL sponsored programs including:
 Tasting Parties,
 Wee Wahoo,
 Wacky Water Wahoo,
 Bike Rodeos,
 Tar Wars presentations,
 Peaceful Playgrounds,
 SPARK, etc.
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SCHOOLS FOR HEALTHY LIFESTYLES
APPLICATION COVER SHEET FOR NEW SCHOOL
2014-15
NAME OF SCHOOL__________________________________________________________
DISTRICT___________________________________________________________________
SCHOOL ADDRESS__________________________________________________________
CITY/ZIP ________________________________ COUNTY _________________________
TELEPHONE #________________________ FAX #__________________________
Grades Served __________ Number of Staff ______
Percent of Free and Reduced Lunch _____ Total Number of Students Served _________
Is your district a 24/7 Tobacco Free district? ______
How did you learn about the SHL program?
We, the undersigned, agree to follow each of the program requirements and spending guidelines
as previously outlined.
SUPERINTENDENT (OR DESIGNEE) SIGNATURE
TYPED NAME
EMAIL ADDRESS
PRINCIPAL SIGNATURE
TYPED NAME
EMAIL ADDRESS
SHL COORDINATOR SIGNATURE/TITLE
TYPED NAME
EMAIL ADDRESS
_____________________________________________________________________________________________
SHL COORDINATOR SIGNATURE/TITLE
TYPES NAME
EMAIL ADDRESS
Please list the SUMMER contact information for the coordinator(s) so we can keep him/her
informed over the summer.
Name ________________________________________________________________________
Summer Address ______________________________________________________________
City/Zip ______________________________________________________________________
Phone __________________________________ Cell ________________________________
Email Address ________________________________________________________________
Please list the SUMMER contact information for the principal(s) so we can keep him/her
informed over the summer.
Name ________________________________________________________________________
Summer Address ______________________________________________________________
City/Zip ______________________________________________________________________
Phone __________________________________ Cell ________________________________
Email Address ________________________________________________________________
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APPLICATION
Be sure to attach the Application Cover Sheet to the front of your responses. Please only use the
space provided.
1. Explain why your school wants to become a part of SHL.
2. Describe what your school has already done to address school wellness.
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3. Has your school previously applied for the Certified Healthy Schools program? If so,
what level is your school?
4. Which community partners have you already worked with to promote school health?
5. After 3 years in the SHL program, what changes do you anticipate/hope to see in the
overall health environment of your schools?
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6. Following the previously listed Grant Spending Guidelines, please list how you plan to
spend your grant. (Your list must total $1,000.)
Item
Price
Example: Parachute, 24’ w/o
handles from Gopher
$130.50
Justification
To replace damaged parachute
TOTAL
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Please fill out the following form listing the SHL activities your school would complete to meet
SHL program requirements.
Month
Activities Completed
Ex. Fitnessgram testing
AUGUST
SEPTEMBER
OCTOBER
NOVEMBER
DECEMBER
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JANUARY
FEBRUARY
MARCH
APRIL
MAY
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