Aetna ICON Grant

Application Form

Overview:

USTA Serves, the USTA and Aetna, Inc. are committed to improving the health, physical activity and academic achievement of youth in at-risk communities throughout the United States. We believe that we can achieve this goal through the integration of tennis, health and education curricula in after-school programs.

The following Grant application seeks schools with 51 percent non-white populations who believe that sports and physical activity are important elements in our youth’s overall educational success; are committed to reducing the health disparity in non-white populations; strive for academic excellence through parent/teacher/volunteer involvement. The schools may not currently provide tennis in elementary physical education or afterschool programs. Teacher/coach of the program is not required to have a tennis background but must be committed to supervising the tennis and education program.

The United States Tennis Association (USTA) will supply all equipment, tennis lines and personalized training for the teacher/coach; Aetna, Inc. will supply volunteers to conduct the education/health portion of the program and USTA Serves (Serves) will provide the financial grant, program evaluation and oversight. Representatives from all 17 sections of the USTA will assist in disseminating materials to schools and providing recommendations.

Proposals are due to the USTA Serves office no later than October 14, 2011. Please submit proposals electronically to Brandon Smith at (We will accept hard copies at the address below if email is impossible). Trainings will begin fall of 2011. Programs will begin by January 2012.

Brandon Smith

USTA/Midwest Section

1310 East 96th Street, Suite 100

Indianapolis, IN 46240

317-577-5131 fax

Requirements:

Schools must house a student population of not less than fifty-one percent (51%) non-white elementary school-aged children.

Schools should have a playground, yard or gym adjoining or in reasonable proximity that can be laid with tennis lines.

All applicants will agree to conduct a tennis, education and wellness program a minimum of three (3) days per week, two (2) hours after school per session and at a minimum of one (1) semester per school year.

Tennis is not currently offered in the elementary school. The assigned supervisor/coach may have, but it is not required to have prior experience in tennis.

The Supervisor/Coach must agree to work with the committee to help coordinate the tennis and education components of the program.

The Supervisor/Coach or other school will agree in year one to report the following to USTA Serves at the completion of the program: track and record program attendance and retention, teach tennis and work with school officials to coordinate program logistics (space, equipment storage, snack as provided by USTA Serves). In year two: track and record program attendance, retention, homework, teach tennis and work with school’s administration to measure other outcomes that would be mutually beneficial. In year three, continue all of the above and any other mutually agreed upon outcomes.

USTA Serves Grant Application (September 2011)

Name of School ______

Address ______

Contact person ______

Principal ______

Email ______FAX ______

Phone: ______

1. Statement of purpose: How participating in this program will benefit the students in your school.

2. Who will lead this program? What teaching/coaching/ or other experience does he/she have in physical education and health and wellness?

3. How will you promote this program?

4. Are you committed to conducting this program a minimum of 3 days per week, 2 (two) hours per day and at least one (1) semester of the 2012 school year?

5. The grant amount awarded will be at least one thousand dollars ($1000.00). Please submit a budget if there will there be additional costs associated with this program. Please indicate where you will get the funds to cover your costs.

6. The program leader will agree to submit a year-end report measuring participants’ attendance, program retention, homework, and overall evaluation of the program (form to be created by USTA Serves).

______

School Representative

Date

______

Principal

Date