PENNSYLVANIA FACULTY HEALTH AND WELFARE FUND P.O. Box Harrisburg, Pennsylvania (717)

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1 PENNSYLVANIA FACULTY HEALTH AND WELFARE FUND (717) GRANTS AVAILABLE FOR UNIVERSITY WELLNESS INITIATIVES Please Read Carefully Before Applying for a Grant TO: FROM: SUBJECT: APSCUF Chapter Presidents APSCUF Health and Welfare Specialists APSCUF Office Managers John J. Lattanzio, Ph.D., Chairperson Brenda A. Mundell, Secretary/Treasurer Pennsylvania Faculty Health and Welfare Fund Grants Available to Benefit Faculty Wellness Activities Encouraged The Pennsylvania Faculty Health and Welfare Fund announces the availability of up to three (3) $1, Wellness Promotion Grants to each PASSHE university every academic year. Each university may apply for up to three (3) grant s in any combination (see types below). The APSCUF Health and Welfare Specialists should monitor the number of grants submitted to the Fund each academic year. 1. The Health Awareness Grant is a $1,500 matching grant for campus-wide wellness and prevention activities such as wellness fairs and single topic wellness sessions. Grant applications must include documentation of dollar-for-dollar matches from campus or community organizations. The funded activities must include faculty participation. 2. The Healthy Lifestyle Grant is a $1,500 grant to fund risk reduction activities that include at least six (6) h ours of programming and include faculty participation. Topics that qualify for grants include, but are not limited to, the following: weight reduction, smoking cessation, healthy eating, exercise and stress reduction. Please distribute this announcement and the appended grant applications to campus newsletters for publication, campus organizations, wellness committees, grant officers and human resource offices. Additional copies of this announcement and the appended applications may be obtained from the Fund Office or downloaded from the Fund s website, Completed grant applications must be submitted to the Fund Office in Harrisburg for consideration by the Fund s Wellness Committee. All grant applications must be submitted using the grant application form, including completion of the questions, and must be signed by an APSCUF Health and Welfare Specialist. Questions regarding the grant program should be directed to Timothy Buchanan at the Fund Office,

2 (Single Session Campus-Wide Activity) Complete in Full - Print or Type Applicant s Name Applicant s Address Applicant s Title Telephone Number University Semester of Program Amount Requested Pay Grant to: Grant Office Contact Person (fall or spring and year) (if applicable) Complete this form in full and have it signed by the APSCUF Health and Welfare Specialist and the applicant (attach additional pages, if necessary). Incomplete applications will be returned to the grant applicant. Mail the application and supporting documentation to the following address. Wellness Committee Pennsylvania Faculty Health and Welfare Fund Grant applications should be submitted to the Fund in advance of the activity. Within 60 days of completion of the activity a report must be submitted to the Fund. Reports must include the number of participants and a narrative describing the activity and its various components. CERTIFICATION: I, we, do hereby apply for a Wellness Grant according to the terms and conditions herewith disclosed. In the event the program applied for is not completed or the necessary report is not remitted to the Fund at the conclusion of the activity, grant monies paid by the Fund will be returned promptly to the Fund. The Fund does not warrant the success of activities and the Fund limits its financial liability to the maximum amount of the grant approved by the Fund s Board of Trustees. APSCUF Health and Welfare Specialist Applicant (both signatures are required) Complete the Back of This Form All Questions Must Be Answered Fully Attach Copy of Required Report if Awarded a Grant Previously

3 HEALTH AWARENESS INITIATIVE Complete All Questions Fully Print or Type Provide a description of the planned event; who will conduct the event; what organizations or entities will participate and what services or materials will they provide (examples: food items, giveaways, screenings and etc.)? How will the faculty benefit from the event and what is the anticipated number of faculty participants? Provide a detailed budget for the planned event (include direct and indirect expenses express values in whole dollars). Matching funds must be demonstrated to be at least equal to the amount of the grant requested. Items to be Purchased for the Program Approximate Cost of Items Purchase with Grant Specify Yes or No Source of Funding if not Purchased with Grant Money (e.g. Donated, In-kind or University Funds)

4 (Small Group Activity Must Include At Least Six Hours of Programming) Complete in Full - Print or Type Applicant s Name Applicant s Address Applicant s Title Telephone Number University Semester of Program Amount Requested Pay Grant to: (fall or spring and year) Grant Office Contact Person (if applicable) Complete this form in full and have it signed by the APSCUF Health and Welfare Specialist and the applicant (attach additional pages, if necessary). Incomplete applications will be returned to the grant applicant. Mail the application and supporting documentation to the following address. Wellness Committee Pennsylvania Faculty Health and Welfare Fund Grant applications should be submitted to the Fund in advance of the activity. Within 60 days of completion of the activity a report must be submitted to the Fund. Reports must include the number of participants and a narrative describing the activity and its various components. CERTIFICATION: I, we, do hereby apply for a Wellness Grant according to the terms and conditions herewith disclosed. In the event the program applied for is not completed or the necessary report is not remitted to the Fund at the conclusion of the activity, grant monies paid by the Fund will be returned promptly to the Fund. The Fund does not warrant the success of activities and the Fund limits its financial liability to the maximum amount of the grant approved by the Fund s Board of Trustees. APSCUF Health and Welfare Specialist Applicant (both signatures are required) Complete the Back of This Form - All Questions Must Be Answered Fully Attach Copy of Required Report if Awarded a Grant Previously

5 HEALTHY LIFESTYLE INITIATIVE Complete All Questions Fully Print or Type Provide a description of the planned program; who will conduct the program; how many program hours will be provided (a minimum of six (6) hours is required); how many faculty are anticipated to participate in the program; and where will the program be held? What are the qualifications and/or professional backgrounds of all individuals who will be conducting the program? Provide a detailed budget for the planned event (include direct and indirect expenses express values in whole dollars). Identify which expenses will be paid for with the grant funds. Items to be Purchased for the Program Approximate Cost of Items Purchase with Grant Specify Yes or No Source of Funding if not Purchased with Grant Money (e.g. Donated, In-kind or University Funds)