MONROE COUNTY HEALTHY SCHOOLS
Application 2015-2016
Applications will be accepted between
January 1st and March 1st, 2016
A school is eligible to receive a Golden Apple School, Silver Apple School, or BronzeApple School Wellness Designation if the school currently fulfills the required number of activities. In order to be eligible for recognition, the school must have an established Coordinated School Health Team that consists of a representative from AT LEAST FIVE of the following areas: nutrition services, health services, physical education department, health education department, safe school environment, family and community involvement, staff wellness, counseling, psychological or social services and MUST include AT LEAST ONE member of the schools administration. The Coordinated School Health Team must meet at least TWO times per year. Each activity is worth ONE POINT. AT LEAST TWO activities have to be completed from each section. The activity requirements for each level of School Wellness designation are as follows:
a.)Golden Apple School – 25 total points/ activities or more.
b.)Silver Apple School – 20 total points/ activities or more.
c.)BronzeApple School – 15 total points/ activities or more.
Activities are listed in the tables on the pages that follow. Please check the box of any activity that your school has completed or will complete for the current school year. Briefly describe the activity on the subsequent pages. If your school has completed any health related activities or updated any health related policies that are not included in the list provided, list that in the “Custom Initiative” space provided to earn additional points. Please describe who was involved, when and for how long was the activity done, and any special achievements under each point. Please enclose any pictures of activities if appropriate.
Submit by March 1st, 2016 to or fax to 734-240-7948.
* School administrator must sign application. Please see last page. *
Category 1: Nutrition Choose a minimum of two in this categoryProhibits use of food as a reward
Prohibits withholding food as a punishment
Offers predominantly healthy food/beverages for classroom celebrations/parties
Prohibits the sale of foods with low nutrient value in school fundraising or fundraising promoted to the students through the school
Predominantly healthy foods and beverages are offered at school events (i.e. low-fat milk and dairy, bottled water, 100% fruit juice, low-fat and low-sugar snacks)
All vending machines on school property contain predominantly healthy food and/or beverages
Positive and consistent messages about healthy eating developed by students are provided throughout the school
Drinking fountains are available for students to get water at meals and throughout the day
Students are permitted to bring water with them to school for use throughout the day
Locally grown food is offered to students at least two times per year
Hosts a speaker related to nutrition and healthy eating
Custom Nutrition Initiative:
Custom Nutrition Initiative:
Category 2: Physical Activity Choose a minimum of two in this category
Students can safely walk, bike or use any other non-motorized physical means of travel to and from school
Prohibits staff from withholding physical education class or recess as a punishment or to make up missed instructional time
Our school has a written policy that prohibits replacement of physical education class with other activities
Adequate facilities are available inside the school for use by physical activity programs and physical education classes and extracurricular programs
Adequate facilities are available outside of the school building for use by physical activity programs, physical education classes and extracurricular programs
Positive and consistent messages about physical activity developed by students are promoted throughout the school
Has an established indoor recess policy that limits sedentary activities and promotes physical activity
Offers recess before lunch
Offers at least 150 minutes of physical activity at the elementary level or 225 minutes per week at the secondary level (middle and high school).
School facilities are available for community to utilize for physical activity
School participates in a Jump Rope for Heart or Hoops for Heart event through the American Heart Assoc.
Hosts a speaker related to physical activity
Custom Physical Activity Initiative:
Custom Physical Activity Initiative:
Category 4: Miscellaneous Category Choose a minimum of two in this category
Our Coordinated School Health Team informs key constituencies of current developments (plans and activities) at least three times each school year
Participates in the MI-PHY Survey (grades 7, 9, 11)
Developed and implemented procedures that ensure both the appropriate consequences and remedial responses to a student or staff member who commits an act of harassment or bullying
Has a procedure in place that eliminates or reduces exposure to asthma triggers
Have policies in place that promote a healthy lifestyle for staff
Participates in the Michigan Green Schools Program
Offers daily opportunities for unstructured physical activity for at least 20 minutes in addition to lunchtime recess
Participates in ACES Program coordinated by the Michigan Fitness Foundation
Offers a health related event or celebration
Offers a physical activity themed event, such as a field day.
Participates in the American Cancer Society Relay Recess or Relay Field Day
Offers a reward program for students and staff who track physical activity and/or nutrition goals, such as myplate.gov
School holds a Red Out For Heart event to raise awareness about heart disease through the American Heart Association
At least one staff member is certified in Mental Health First Aid for Youth
Utilizes an evidence-based health education curriculum, such as the Michigan MODEL
Students are introduced to health resources and services available in the community
School hosts a blood drive with at least 40 participants
School provides training on CPR, First Aid and/or Babysitting
A Cardiac Emergency Drill is performed annually
Coordinates a program to educate students on the dangers of distracted driving
Offers classes or programs that encourage parental involvement and educational opportunities
OK2Say Program is promoted throughout the school building
Custom Wellness Initiative:
Custom Wellness Initiative:
Please briefly describe each initiative undertaken this school year as indicated by a check in the pages above.
Activity/ Policy 1:
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Activity/ Policy25:
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Please attach additional sheets if necessary.
Additional Comments/ Suggestions to improve the Monroe County Healthy Schools Program:
Please print legibly if handwritten
Principal’s Signature:Principal’s Name:
Principal’s phone number:
Principal’s email address:
Program Coordinator’s Name:
Program Coordinator’s phone number:
Program Coordinator’s email address:
Date:
Submit by March 1st, 2016 to or fax to 734-240-7948.
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