HEROES Initiative – 2017 Application Format Review the documents on the website to become familiar with the HEROES Initiative. If your school is interested and would be committed to implementing the HEROES coordinated school health model as described, please complete the following application. Organization Information School Name Street Address City State Zip/Postal Code Phone Current Enrollment Grades taught In the spaces below, please enter information related to the school administrator for this request Prefix First Name Last Name Title Office Phone Email Address In the spaces below, identify the person completing the grant application. Prefix First Name Last Name Title Mobile/Summer Phone Email Address If Wellness Coordinator(s) are different than the grant application writer, please list names and titles here. It is recommended that newly established wellness coordinators have been in their current position for at least one year. In the case in which two co‐coordinators are assigned, at least one individual should fit this description Coordinated School Health Model Please complete the following section related to your school’s participation in the Coordinated School Health Model. 1. Conduct and report results of HEROES Needs Assessment o Download Needs Assessment excel file from HEROES website www.heroesinitiative.org o Distribute components to appropriate staff members to score each line item. (Include food service, administration, physical educators, nurse, etc.) Compile component scores into the Needs Assessment excel file for an overall score summary. o Save the file as SCHOOL NAME_Needs Assessment.xlsx o Upload in the attachment section of the application 2. Describe any Coordinated School Health (CSH) history within the school building. Include any of the following: appointed wellness coordinator, active wellness council, and wellness policies specifically supporting and promoting movement and healthy eating. (Example: addressing classroom celebration and reward food, non‐food fundraisers, active recess, not withholding recess for punishment, etc.) 3. Discuss the level of support of school wellness from school administration and groups (such as superintendent, school board, principal, faculty/staff, athletic department, PTO/PTA, cafeteria, and physical education department.) How will these groups be involved in the implementation of the Coordinated School Health model? How will these groups be obstacles to the implementation of the Coordinated School Health model? 4. In five sentences or less, what inspires you to apply for this program? o
HEROES Program The CDC’s Coordinated School Health model (also known as Whole School, Whole Community, Whole Child) is comprised of ten components. The HEROES Initiative is a childhood obesity prevention program and thus, focuses on five of the ten components of health that pertain to healthy eating and active living. For numbers 4‐8, identify these three points in each component: Honest feedback is appreciated. Previous evaluation of HEROES shows all schools have experienced challenges when implementing a healthier school culture. We understand change is hard and the Foundation seeks opportunities where HEROES can make favorable impact. a) What are your existing assets and strengths in this area? b) What do you anticipate the challenges might be in this area? c) In what ways will you need support from the Welborn Baptist Foundation to further strengthen your assets and overcome your obstacles? 5. Physical Activity and Physical Education 6. Nutrition Environment and Services 7. Health Education 8. Employee Wellness 9. Family Engagement and Community Involvement 10. Please include your school's plan to sustain HEROES once the school completes the active funding period. Identify potential sources of funding for sustainability and how a positive momentum will be kept by the school community members to continue the HEROES Initiative. Include how a wellness coordinator position and an active wellness council will play a role. Acknowledgement 11. I have reviewed the HEROES Initiative grant budget and purchase guidelines. (HEROES 2017 Budget and Purchase Lists – found in Application Packet on website) Y/N 12. I have reviewed the HEROES Initiative grant budget and purchase guidelines with required parties at both the corporation and school‐building levels. (HEROES 2017 Budget and Purchase Lists – found in Application Packet on website) Y/N Attachments: Please upload the following documents: Completed HEROES Needs Assessment in .xlxs format
Using the provided templates located in the application packet on the website, attach letters of support from the following entities describing how their position will assist in the implementation of healthy school policy and environmental change. These letters of support should be combined and uploaded as a single .pdf document. Corporation Superintendent School Building Principal Cafeteria Manager PTO/PTA/Booster Organization President Physical Education Department Athletic Director (if applicable) HEROES Initiative supported by the Welborn Baptist Foundation HEROES Team – Laura Mesker and Chrissy Ash 21 SE 3rd Street, Suite 610 Evansville, IN 47708 | 812.437.8260