Deadline: August 31, 2017
General Information
For any Texas school district or campus that would like to begin a new health project or has started a new health project that has been in place less than a full school year. Winners would use the award money as start-up seed funding to put the project into action.
Name of Project:
Project Coordinator’s Name:
Project Coordinator’s Title:
Project Coordinator’s Phone Number: / Alternate Phone Number:
Project Coordinator’s Email Address: / Alternate Email Address:
Enter “X” to select how you learned about the Awards for Excellence in Texas School Health.
DSHS Friday Beat e-newsletter
DSHS School Health Program Website
Conference, Workshop, or Meeting
Colleague
Other:
District Information
Name of School District:
Superintendent Name:
District Tax Identification Number: / County:
District Street Address:
City: / Zip Code:
Campus Information
District applicants please skip this section.
Name of Campus:
Principal Name:
Campus Street Address:
City: / Zip Code:
Checklist
Enter “X” for checklist items you complete to ensure you have covered important steps in the process.
Our school district has a school health advisory council (SHAC).
Our SHAC approved this project and a letter of support is included with this application.
Our district has adopted a Texas Education Agency approved coordinated school health program for grades K-8.
This project aligns with one of the ten components of the Whole School, Whole Community, Whole Child Approach to School Health.
We have determined that there is a need for the project.
We have developed a plan on how to implement this project.
We have set goals and measurable objectives for this project.
We have received support from campus staff for this project.
We have received support from campus or district administration for this project.
We have received support from the community for this project.
We plan to track the results for this project.
We plan to continue this project if our results are successful.
This project is designed to be easily replicated on another campus or district by other school staff or volunteers.
If we win the 2017 Reaching for Excellence Award, we plan on applying for the 2019 Discovery Award to expand the project.
Summary (10 points)
Explain the need and target population for the project. Include information from any surveys or interviews that you used to identify the need for this project.
Provide a summary of your project. Briefly outline activities that will be included in the project.
Goals (25 points)
What is the main goal of the project?
Before the creation of the goals, was there a needs assessment conducted?
Yes No
Objectives (25 points)
List the measurable objectives of the project.
What results do you expect to accomplish with this project?
Activities (15 points)
List and describe the activities that will take place throughout the project. Consider activities related to planning, implementation, and follow-up. For each activity, identify the person who will oversee or coordinate the activity.
Activity 1: / Activity 1 Responsible Person:
Activity 2: / Activity 2 Responsible Person:
Activity 3: / Activity 3 Responsible Person:
Activity 4: / Activity 4 Responsible Party:
Activity 5: / Activity 5 Responsible Party:
Activity 6: / Activity 6 Responsible Party:
Activity 7: / Activity 7 Responsible Party:
Activity 8: / Activity 8 Responsible Party:
Activity 9: / Activity 9 Responsible Party:
Activity 10: / Activity 10 Responsible Party:
Collaboration (25 points)
Explain the role of the SHAC in the approval, development, and implementation of the project.
List individuals (by position) and groups in the school* who will be helping with the project. Also, describe what each individual and group will do to help with the project.
List individuals (by position) and community organizations outside the school* who will be helping with the project. Also, describe what each individual and organization will do to help with the project.
Award Funding (5 points)
The Reaching for Excellence award money is for start-up funding to put the project into action. If this project is selected, how will the award money be used?
Budget (5 points)
List the project’s expected budget items, quantities and estimated cost of the items. Please give details focusing on how these items will help achieve the project results.
If you have questions, contact the Texas Department of State Health Services’ School Health Program at or (512) 776-7279.
DSHS (8/16) Reaching for Excellence Application Page 4 of 4