2014-2015 Sangamon County Excellence in School Wellness Award
Deadline: September 30th, 2015

The Sangamon County Excellence in School Wellness Award was created to recognize public and private schools in Sangamon County that have taken steps to create a healthy environment for their students and staff in the areas of nutrition education, school food, physical activity, staff wellness, and more. A healthy school environment is positively associated with academic achievement and improved behavior, helps prevent childhood obesity, and decreases the risk of future chronic diseases by promoting ideal health practices among youth.

Schools are the places to teach the best practices in every subject, and Sangamon County schools are making changes to the environment, school food, and policies so that nutrition and physical activity become second nature to current and future students. We will reap the benefits through a new generation of healthy, thriving youth and a healthier future for Illinois. For their commitment to their students’ health, we would like to recognize their efforts with this award.

Annually, schools in Sangamon County will be selected to receive the Sangamon County Excellence in School Wellness Award in Gold, Silver, or Bronze. Winners will be chosen and contacted in October 2015. Winning schools will be recognized and awarded their Certificate of Excellence during the next school board meeting for their district.

ELIGIBLE SCHOOLS INCLUDE:
• K-12 Public schools within Sangamon County
• K-12 Private schools within Sangamon County
• K-12 Alternative schools within Sangamon County
• Additional consideration will be given to schools with a free/reduced lunch population above 40% and first time applicants, however all schools are highly encouraged to apply
• Qualifying school wellness activities must have taken place in the 2014-2015 school year (August 1, 2014 – July 31, 2015)

BASELINE REQUIREMENTS:
• Have a written, district wellness policy
• Have a school wellness team – Additional consideration for teams that include a principal, parent(s), student(s), and/or community member(s)
• Elementary schools: Offer a minimum of 75 minutes of physical activity each week (includes Physical Education (PE) classes and recess)
• Middle schools: Compliant with daily PE requirements for all students, other than exempt students
• High schools: Compliant with daily PE requirements for all students, other than exempt students

SCORING RUBRIC:
• Nutrition & Activity – 60 points maximum ( Food Service – 20 points; Nutrition/Nutrition Education – 20 points; Physical Education/Activity – 20 points)
• Outreach – 30 points maximum (Marketing/Promotion – 15 points; Family/Community Involvement – 15 points)
• Staff Wellness – 10 points maximum)
• Bronze Category (30-50 points), Silver Category (51-70 points), Gold Category (71-100 points)

A COMPLETE APPLICATION CONSISTS OF:
1. Copy of your district wellness policy
2. School Information Form (submit online by Wed, September 30th, 2015)
3. Excellence in School Wellness Award application (submit online by Wed, September 30th, 2015)
4. Extracurricular Program Form (print, sign & send)
5. School Administration Signature Page (print, sign & send)

AWARD CONTACT (Please direct any questions, concerns, or documentation to the following contact):

Whitney Ajie
University of Illinois Extension
Illinois Nutrition Education Programs
700 S. Airport Drive
Springfield, IL 62707
Phone: 217-782-4617
Fax: 217-524-6662
Email: ajie2@illinois.edu

Access to all necessary forms can be found here: http://web.extension.illinois.edu/lms/eb334/entry_10544/.  

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Special thanks to our community partners in Sangamon County who support & appreciate our schools’ efforts to improve school wellness!
School Information Form
* = required question
School district *
School name *
School address *
Street address, City, Zip
Main phone *
Main fax
optional
Percentage free/reduced lunch
Optional. Schools with 40% or higher will receive additional consideration.
Principal Name & Email *
Physical Education Teacher Name & Email *
Food Service Director/Manager Name & Email *
School contact person for Award *
Name, phone and email
Best way for Award contact person to be reached
Email or phone
Clear selection
Is this the first year that your school is applying for the Sangamon County Excellence in School Wellness Award? *
How did you hear about this award? *
Do you give permission to the Awards Council to share any of your submitted policies, activities, programs, and/or documentation for future outreach or educational purposes (e.g. resource guides, best practices, success stories, etc.)? *
Do you give permission for supporting partners of the award to contact you regarding school wellness opportunities, resources, programs, and/or grants for your school? *
Instructions
Please respond to the following application questions in the critical areas of school wellness: Food Service, Nutrition/Nutrition Education, Physical Education/Activity, Marketing/Promotion, Family/Community Involvement, and Staff Wellness.

Under each heading, there is a checklist of several questions and an open response section. The open response section is optional, but highly encouraged. It allows you submit a written description to illustrate how you have supported and implemented your school’s wellness goals in each area. The more details you provide, the better the Awards Council can assess your school’s efforts. You do not have to answer every question, unless it is a required question; however, you will only be assessed by the questions that have a response. Schools will receive a score between 0-100, and will compete for the Gold, Silver or Bronze awards - Bronze Category (30-50 points), Silver Category (51-70 points), or Gold Category (71-100 points). Within each category, an overall winner will be announced as a Bronze with Distinction, Silver with Distinction, or Gold with Distinction winner. To select the overall winner, the final score as well as the additional documentation and open responses submitted will be considered.

Activities must have taken place between August 1, 2014 and July 31, 2015. Examples of what to include in your open response are:  detailed explanation of the activity, who and what was involved in planning and implementation, the duration of the activity and/or how long the activity has been maintained, how the activity is/will be monitored or maintained over time, how the activity has impacted students, parents and/or staff (e.g. in-class behavior, attendance, truancy, grades, fitness tests, trips to nurse/principal’s office, plate waste, involvement, attitudes, efficiency, instructional time, etc.), how the activity meets your school’s needs or satisfies part of the wellness policy, any community or family involvement, how the activity was innovative or creative, how money was raised or grant funding was received, and similar relevant information.

Additional documents (including pictures and video) are encouraged if they support or further explain your activities in each section. You may send documentation to the contact listed above. When submitting supporting documentation offline, please label the documents as to which section they are supporting, i.e. Food Service, Nutrition/Nutrition Education, Physical Education/Activity, Marketing/Promotion, Family/Community Involvement, or Staff Wellness. Please label your supporting documents with the appropriate section on the top right-hand side.  

Please submit a copy of your district’s wellness policy, as well as any rules & regulations for the policy, with your completed application via email, fax or mail. If your individual school has added policies or rules that go above and beyond the district’s policy, please include those as well.

Excellence in School Wellness Award Application
* = required question
Do you have a district wellness policy as required by federal law? *
Do you have a district wellness committee or team? *
Do you have a school wellness committee or team? *
Who is involved on your school wellness committee or team? *
Check all that apply
Required
How long have you had a school wellness committee/team? *
How often does your school wellness committee/team meet during the school year? *
Do you participate in the National School Breakfast and/or Lunch Program(s)? *
If yes for NSBP, what is your participation rate?
Optional
If yes for NSLP, what is your participation rate?
Optional
If no, what are you nutrition guidelines for breakfast and/or lunch?
Are your school meals currently in compliance with the current federal school meal standards? *
Are the a la carte and competitive food and beverage items in compliance with the federal Smart Snacks guidelines? *
Does your school have a salad bar or fruit/vegetable bar?
Clear selection
Do you purchase any local foods to be served in your school meals?
Clear selection
If yes, what do you purchase?
Check all that apply
If you have a school garden, is any of its produce served as part of school meals?
If served elsewhere, please describe in 'Other'
Clear selection
Have you implemented any alternative breakfast models in your school to increase breakfast participation, i.e. breakfast in the classroom, grab & go, second chance breakfast?
Clear selection
Have you completed the USDA Smarter Lunchrooms checklist?
Clear selection
If yes, have you implemented any improvements or changes recommended by the USDA Smarter Lunchrooms Movement?
Clear selection
If yes, what changes did you make?
Does your school provide an after-school meal program?
Clear selection
Is your school a summer meal site?
Clear selection
Does your school food service provide meals to summer meal sites?
Clear selection
How much time do students have to eat breakfast? *
How much time do students have to eat lunch? *
How many days per week is a fresh fruit or vegetable served at breakfast?
Clear selection
How many days per week is a fresh fruit or vegetable served at lunch?
Clear selection
Is non-fat flavored milk served daily? *
If not, how often is it served?  
For breakfast and/or lunch
Have you provided taste tests in your lunchroom for items on the school menu?
Clear selection
Have you provided taste tests for fruits & vegetables (other than the Fresh Fruit & Vegetable Grant)?
Clear selection
What percentage of your school food items are made “from scratch” or “in house” rather than pre-packaged or “heat & serve”?
Use your best estimate for breakfast and lunch
Open response: Please submit a written description (and/or send additional documents) further explaining or illustrating your school’s wellness efforts in the area of Food Service, especially about the questions to which you answered ‘yes’.
Do you have a written policy or rule that decreases or prohibits unhealthy food(s) during school celebrations, e.g. classroom celebrations, birthdays, student of the month, etc.? *
Do you have a written policy or rule that decreases or prohibits unhealthy food(s) or candy as a classroom reward? *
Does your school participate in the Fresh Fruit & Vegetable Promotion Program?
Clear selection
If yes, how often do teachers or other staff provide nutrition education to students as recommended for this program?
Clear selection
If you are providing fruit & vegetable tastings another way, please describe.
Have you had external people or organizations provide nutrition education in the classroom, e.g. Ag in the Classroom (Sangamon County Farm Bureau), OrganWise Guys (UI Extension), Brain Breaks (genHkids), Dietitians, Health Educators, Doctors, etc.?
Clear selection
Have you had internal staff provide nutrition education in different classrooms, e.g. nurse, food service, PE teacher, health teacher, etc.?
Clear selection
Has the school or any classrooms participated in Farm to School programs or education?
Clear selection
Does your school have a school garden? *
If yes, are you using a garden curriculum to teach students about nutrition? *
If not, is the garden used by classroom teachers (including PE/Health teachers) to enhance any parts of their standard curriculum? *
Do students have unrestricted access to free, safe, unflavored water, e.g. water bottles allowed in classrooms, water fountain or cups of water accessible during class/breakfast/lunch/recess, etc.? *
Have you organized, or do you offer, any healthy fundraisers?
Clear selection
If yes, how many per school year?
Clear selection
Did you ask for any fundraising exemptions? *
If yes, how many?
Clear selection
Have you offered healthy options during school sporting events or concession stands outside of the school day?
Clear selection
If yes, what options?
Have you offered healthy options in vending machines for students or staff?
Clear selection
If yes, what options?
Have you organized a health fair or wellness day for students or families?
Clear selection
Have you provided healthy food choices and/or opportunities for physical activity during student and/or family events at your school?
Clear selection
Open response: Please submit a written description (and/or send additional documents) further explaining or illustrating your school’s wellness efforts in the area of Nutrition/Nutrition Education, especially about the questions to which you answered ‘yes’.
Are you compliant with the state requirements for daily Physical Education?   *
If not, why not?
Did your school or district request a Physical Education waiver or waiver extension from the state for 2014-2015?
Clear selection
Do you have a certified PE teacher on staff?
Clear selection
How often do you offer active indoor recess?
Clear selection
Do you have use agreement allowing the general public to use your physical activity area outside of school hours?
Clear selection
What percentage of classroom teachers uses brain breaks or activity breaks on a regular basis?
Give your best estimate
(Elementary, Middle schools) How many minutes of PE do students receive each week?
(High schools) How many semesters or credits of PE are required in your school?
Are students moderately to vigorously active at least 50% of the time during PE?
Clear selection
(Elementary schools) How often do you offer recess?
Clear selection
How much time do you give students for recess?
Do you offer recess before lunch?
Clear selection
Do you have a written policy or rule prohibiting the withholding of PE or recess as punishment?
Clear selection
Do you offer additional opportunities for physical activity during, before or after school, e.g. genHkids Jump Start, Girls on the Run, a walking or running club, garden club, etc.?
Clear selection
Do you have, or have you offered, a walk/bike to school program, e.g. Safe Routes to Schools, walking school bus, or another program?
Clear selection
Open response: Please submit a written description (and/or send additional documents) further explaining or illustrating your school’s wellness efforts in the area of Physical Education/Activity, especially about the questions to which you answered ‘yes’.
Does your school participate in any of the following healthy school challenge programs/school wellness programs?
Check all that apply
Do you publicize information about your school’s wellness efforts?
Clear selection
If yes, where do you publicize?
Check all that apply
Do you provide information about health, nutrition, or physical activity to your parents/families on a regular basis?
Clear selection
If yes, where do you publicize to parents/families?
Check all that apply
If yes, how often do you publicize to parents/families?
Clear selection
Did you have posters, billboards, marquees, or other promotional materials that advertise for food or beverages that were not in compliance with the Smart Snacks guidelines?
e.g. Pepsi, Coca Cola, M&M’s, etc.
Clear selection
Where do you have posters or promotional materials about obesity prevention, drinking water, nutrition/healthy eating, or physical activity?
Check all that apply
Have you organized contests focusing on nutrition, physical activity, or wellness-related themes for students and/or families?
e.g. coloring/art/poster contests, walking contests, jump rope contests, video/picture contests, 5K, etc.
Clear selection
Have you celebrated as a school any nutrition/wellness-related holidays (either nationally recognized, state, local, or created by the school)?
e.g. National Nutrition Month, National School Lunch Week, National Childhood Obesity Awareness Month, National Strawberry Day, Diabetes Awareness Month, Heart Month, Rethink Your Drink, etc.
Clear selection
How often do you present feedback to your district and/or superintendent about your school’s wellness progress?
Clear selection
Open response: Please submit a written description (and/or send additional documents) further explaining or illustrating your school’s wellness efforts in the area of Marketing/Promotion, especially about the questions to which you answered ‘yes’.
Do you have external people or organizations providing nutrition or physical activity education/programs at your school during, before, or after school?
e.g. CATCH Kids Club, Kids in the Kitchen, genHkids Jump Start, Girls on the Run, etc. IF YES, please complete the Extracurricular Program Form and submit it with your completed application.
Clear selection
If you have a school garden, are parents or community members involved in maintaining the garden?
Clear selection
If you have a school garden, are students involved in maintaining the garden?
Clear selection
How often do parents volunteer for wellness events/programs?
Clear selection
Have family members been actively engaged in planning or implementing one or more wellness events/programs?
Clear selection
Have you involved your PTO/PTA committee in helping you meet your school’s wellness goals?
Clear selection
Do you have community organizations or community members working as partners or sponsors helping you achieve your school’s wellness goals?
Clear selection
Are parents or family members advised as to when school wellness meetings are held?
Clear selection
Have you applied for any grants or awards to help you achieve your school’s wellness goals? *
In the 2014-2015 school year
If yes, which grants/awards?
Open response: Please submit a written description (and/or send additional documents) further explaining or illustrating your school’s wellness efforts in the area of Family/Community Involvement, especially about the questions to which you answered ‘yes’.
Has the administration or staff organized staff wellness opportunities?
Clear selection
If yes, how often?
Clear selection
What staff wellness topics or issues have you covered in your events/programs?
Choose all that apply
Does the staff receive information about how to improve their own health on a regular basis, either from school administration or from the school wellness team?
Clear selection
Have health assessments for staff been offered for free or low-cost through the district or school at least once per year?
Clear selection
Does the staff engage in healthy meetings, e.g. using the methods outlined by the American Cancer Society or National Alliance for Nutrition and Physical Activity?
Clear selection
Open response: Please submit a written description (and/or send additional documents) further explaining or illustrating your school’s wellness efforts in the area of Staff Wellness, especially about the questions to which you answered ‘yes’.
School Administration Signature Page
By signing below, I hereby declare that the information stated above is truthful and accurate to the best of my knowledge.

By signing below, I also agree to allow the Awards Council to reproduce text, images, and video submitted as part of this application for marketing and educational purposes, within and outside of Sangamon County, in relation to the Sangamon County Excellence in School Wellness Award.

School Principal *
Electronic Signature
Award Contact Person *
Electronic Signature
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