PHIT America GO! Grant Application

**APPLICATIONS DUE JUNE 1st**

$1,000-$5,000 GO! Grants support sustainable, low-cost programs before, during, and after school that increase students’ physical activity minutes toward the nationally recommended 60 minutes per day. Funds can be utilized for high-quality programs, professional development and gear.

A. APPLICANT AND CONTACT INFORMATION

("Champion" for this grant)

First Name:
Last Name:
Primary role within the school (parent, teacher, administration, etc.):
Email:
Confirm Email:
Phone:

SECONDARY CONTACT INFORMATION

First Name:
Last Name:
Primary role within the school (parent, teacher, administration, etc.):
Email:
Phone:

How did you learn about the GO! Grants?

Facebook
PHIT America
Let's Move! Active Schools
Word of Mouth
SHAPE Conference
Other, please specify... ______

B. SCHOOL INFORMATION

Name of School:
School Federal ID #:
Street Address:
City:
State: / Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
... 30 additional choices hidden ...
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Zip Code:
Phone:
School Website:

Principal Contact Information

Name of School Principal:
Email:
Confirm Email:
Phone:

Type of School (select all that apply):

Elementary
Middle
Public
Charter

Student Enrollment

Is your school a Title 1 school?

Yes
No

Demographic Breakdown

(optional)

Male / Female
Asian
African-American
Hispanic
Native American
White/Caucasian
Other

Age Breakdown

Male / Female
Age 3-4
Age 5-7
Age 8-10
Age 11-13

Number of weeks per year your school meets (1-52):

What is the average number of hours a child is active per week at your school? (Combination of PE and recess)

Is your school registered as a Let’s Move! Active School?

Yes
No

If “No”, all GO! Grant awardees will be required to make the initial step to sign up as a Let’s Move! Active School before receiving a grant. (https://www.letsmoveschools.org)

If your school is awarded a GO! Grant, to whom should the check be made out to? (must be school, school district or PTO/PTA)

C. PROJECT INFORMATION

Project Name:

Two-three sentence summary of project:

Is this a new project or an enhancement of an existing project? (see GO! Grant Guidelines at top right of page)

Was the project chosen from our list of resources or designed by your school?

Chosen from KIDS in the GAME's list of resources
Designed by my school

Will you subcontract with a non-profit organization or deliver the project yourselves?

Subcontract with a non-profit organization
Deliver the project ourselves

Nonprofit Details

Tax ID numbers may be found on nonprofit website.

Name
EIN or tax ID Number

Dates of project

From

____/__/__ (YYYY/MM/DD)

Dates of project

____/__/__ (YYYY/MM/DD)

Requested GO! Grant amount:

Please enter only numerical values

If we are unable to fulfill the requested amount, what is the minimum amount needed to ensure your program will occur?

Please enter only numerical values

D. PROJECT DESCRIPTION (40 POINTS)

**We encourage brief but clear answers that help give a strong narrative of your proposed project**

The student population you plan to serve, and why you are choosing this particular group:

Use the following bullet points to help guide the description of your project:

Need or challenge your project addresses How your project will meet the challenge: describe your project and how it addresses the stated need, and

What objective performance measures will you use to determine positive changes in your students’ activity levels, fitness, commitment to continue activities?

Resources and tools you will use to structure and implement your project:

E. PROJECT ACTIVITIES (10 POINTS)

**We encourage brief but clear answers that help give a strong narrative of your proposed project**

Estimated number of students involved in project:

Number of days per week the project will be offered:

Number of hours per week students will be active in the project:

Specific activities offered:

Facilities to be used:

Will the school host the project or will it be hosted at a different location in the community?

Equipment needed for the project: (your school may be eligible to receive an equipment grant from our partner, Good Sports.)

Please list general equipment needed and how it will be used for the project. In the Budget section, you will provide a detailed list for all equipment requested.

F. PROJECT STAFFING (20 POINTS)

**We encourage brief but clear answers that help give a strong narrative of your proposed project**

Who will help operate your project? Paid staff, volunteers, student aides? Why did you choose this particular staffing setup?

What training will be offered to project staff?

Use the following bullet points to help guide the description of your staffing plans:

Who is your champion (project overseer and implementer)? Why was s/he chosen? If you are sub-contracting with a non-profit organization to implement your project, explain their missionand why you believe they can accomplish the goals of your project.

G. PROJECT SUSTAINABILITY: (15 points)

How will you keep it going? How will you continue to monitor improved fitness levels among your students? What are the plans to help fund the program in the future?

H. PROJECT BUDGET (15 points)

Please use only numerical values. Do not include dollar sign ($), commas (,) or decimals (.00)

REVENUES

GO! Grant Funding

Amount Requested:

Other Funds

(optional)

Other grants
Fundraisers, events, etc.
Donations
School allocation
District allocation
Other (specify amount)
In-kind (estimate monetary value)

Total Revenue:

If you receive an error message, make sure you have only entered numerical values above.

EXPENSES

**GO! Grant fundscannotbe used for staff salaries or administrative & office supplies. The total GO! Grant expenses should add up to the amount you are requesting at the top of this page.**

GO! Grant Funds / Other Funds
Staff
Professional Development
Marketing/Outreach
Gear & Sports Equipment
Facilities
Transportation
Programming & Fees
Sub-contracting costs (not included above)
Other

Total Expenses:

If you receive an error message, make sure you have only entered numerical values above.

If you have requested gear as part of your proposal, please share the purpose of the request. (Your response will help us with reporting to the sponsors providing gear.)

Budget Summary

Please review that your Total Revenues equal your Total Expenses. If they don't, go back to the previous page and update.

Total Revenue:

Total Expenses:

Hidden Value

GO! Grant Equipment List

Please only list gear and equipment that will be used to promote physical activity. Do not list any administrative or office supplies such as paper or pencils.

Item / # Requested / Price per unit / Total Cost / Description (i.e. brand, size, color, etc.)
Basketballs
Footballs
Soccer balls
Volleyballs
Kickballs
Dodge balls
Medicine balls
Kettle balls
Tennis balls
Baseballs
... 2 additional choices hidden ...
Jump ropes
Hula Hoops
Frisbees
Pedometers
Heart rate monitors
Yoga mats
Equipment packs
Exercise bands
Mini Hurdles
Agility ladders

#10

If your equipment request is not included on the drop down menu above, please include it here. Also list any additional equipment requests beyond those listed above. Please include description, quantity, and cost.

Thank you for submitting your application and for your commitment to increasing physical activity among students at your school. We are in the process of receiving applications through June 1, and will determine which schools will receive grant awards by the end of July. Please feel free to visit our Resources page to continue learning about successful programs and find opportunities for additional funding.