Thank you, Sara Pelkey. Advocates for Healthy Youth, Center for Population Health, Cheshire Medical Center, 580 Court St, Keene NH 03431

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1 The Advocates for Healthy Youth (AFHY) community coalition is pleased to offer limited financial assistance to schools, pre-schools, summer programs, after school and other youth programs in the Monadnock Region for the school year. Note: For profit entities are eligible if the project proposed is for the active involvement of youth and benefits their physical activity or nutritional health AND there is no cost for participation and no profit will be made from the project. Through this small grant program, we wish to expand AFHY's successful efforts to identify and create sustainable programs that promote healthy activity and nutrition options for our youth. We feel that helping Monadnock programs that serve youth to implement a unique idea or project will promote healthy life choices for all children in our service area. AFHY accepts applications throughout the school year until funds are depleted. We review applications and determine awards throughout the year. We will review all grants received by the first 5 days of the month. For example, in April we will review all grants received by April 5th. Innovative ideas are encouraged. In the past, we have sponsored purchasing of durable equipment such as snowshoes, jump ropes, climbing walls and culinary equipment. We have assisted with outdoor activity spaces and the establishment of afterschool activity and gardening clubs. We have also sponsored train the trainer programs such as dance and a puberty education project that included teaching rural middle schoolers how to make healthy leisure choices when moving to a much larger middle and high school. As you can see, we have a broad view of acceptable projects as long as they promote nutrition and/or physical activity. However, we do not fund proposals for one time use/consumable expenses such as transportation or entrance fees. The enclosed information provides an overview of AFHY and instructions on how to apply for grant funds through this initiative. Should you have any questions, please feel free to contact me at ex 2321 or at spelkey@cheshire-med.com. I am happy to discuss possible ideas you might have, answer questions or provide assistance in submitting a request. We want the money to be used for the benefit of youth rather than returning unused funds. Thank you, Sara Pelkey

2 Healthy Activity and Nutrition Projects for Youth Request for Financial Assistance The Advocates for Healthy Youth community coalition is accepting applications for small grants ($250-$1,000) to create or enhance youth programs in the Monadnock Region that promote healthy activity and nutrition choices. Cheshire Medical Center/Dartmouth-Hitchcock Keene convened the group in 2002 in response to physicians concerns about the number of overweight children they were seeing in their practices. Funds can be used for lasting, durable purposes (i.e. pedometers but not T-shirts, cooking equipment but not food items) or program materials. Funds may also pay for staff or consultant trainers that will work directly with youth in the program, provided there are plans in the proposal for continuing the program beyond the grant period (such as train the trainer). We are looking to fund pilot projects that you would like to continue into the future, not a project that is done once that will not be done again. *Note: Grant request over $1,000 will be taken into consideration for individual projects that fall within the suggested guidelines. From our years of experience, AFHY has learned that it is vital for programs to partner with families. This will be an essential component of funded programs. We are also looking for projects that will continue to be implemented and have an impact beyond the year the grant is received. AFHY has also found that the presence of five elements strongly correlates to the success of a project. The involvement of these elements will be clear in a good proposal. Understanding the Community (III.1) Recognizing that Change Will Take Time (IV) Engaging Diverse Participation in Planning and Implementation (II.6) Engaging Families (III.3, II.5) Identifying and Using Outside Resources (III.2) AFHY asks you to keep your application brief but provide enough information for us to understand what you want to do and determine if it falls within our grant goals and purpose. Please submit one to three pages that provide information in the categories that are bolded on the next page. Please note that the questions are only to help understand the types of information that could be helpful but in no means represent questions that must be answered as long as you have given an explanation for each of the categories that are bold. Refer to the example to see how an application might look. The budget can be submitted on a separate page and is not necessarily included in the three page limit. Send proposals by to: spelkey@cheshire-med.com.

3 APPLICATION COMPONENTS Section I: Applicant Information 1. Name and address of applicant organization 2. Contact person, address and phone number (and address if different) 3. Amount requested 4. If you are not a school, give a brief introduction to your organization. 5. Healthy Monadnock or 5210? Please let us know if you are a Healthy Monadnock school or organizational champion or a 5210 participating school. (This is not a requirement but just for our information.) Section II: Project Description 1. Purpose: Why do you want to undertake this project? What issues are you trying to address and how do you think the project will affect those issues? 2. Impact: Who will be involved in and benefit from the project and what changes do you think will result? What difference do you think your project will make to both youth and their families? If the applicant is a for-profit entity, indicate clearly how the project benefits youth in the community and why it is being proposed. 3. Actions: How are you going to accomplish your project? What are you planning to do? What actions will be taken? 4. Timeline: Give a brief timeline for when you anticipate these actions will take place. Include in the timeline when evaluation and reporting back to AFHY on your project results will be done. Please also include actions you will take to ensure sustainability of the project beyond the funding period. 5. Evaluation: How will you know if your project is a success; if you have reached your goals? What do you know about your participants before you start? How will you track who participated? What changes will you see in your participants after your project and how will you measure this? What changes will you see in families? How will you share your results with AFHY and others who might want to replicate your project? 6. Diverse Representation: Who are the key members involved in planning the project? How have people across the spectrum of your community been included in planning this project? Who will be involved in implementing the project? How will you communicate with the community about progress and outcomes? Section III: Engagement and Resources 1. Community: What are the strengths and challenges within your organization, community, and intended audience? How will you leverage these strengths and address these challenges in implementing your project? 2. Resources: What resources do you bring to the project from your organization? Who will partner with you on this project and what resources will they bring? What other community resources will you be taking advantage of? 3. Family Involvement: Families are key to helping youth create new habits. How will you connect with families and inform them about the project? How will they be involved in the project (remotely or directly)? How will you engage families in using project actions outside of your program and/or at home?

4 Section IV: Recognizing that Change Takes Time 1. Program Continuation: When the pilot project is over, how will the program continue? What actions do you anticipate will carry on in your long term programming? How do you think the community will continue to be impacted? 2. Partnerships: How do you think the partnerships that were established will continue to connect with your future programming? Section V: Budget Use this form to outline the budget for this project. You may delete the example and add rows as needed. AFHY funds can be used for lasting, durable purposes (such as pedometers but not T-shirts, cooking equipment but not food items) or curriculum or program materials. Funds may also cover reasonable expenses for a consultant or trainer that works directly with youth while training staff provided there is a plan for continuation of the program after the grant period (train the trainer). We DO NOT fund one time, consumable expenses. For example transportation, entrance fees, and bottles of water. Please explain each item of expense. If the applicant is a for profit entity, please clearly indicate what costs are being covered by the applicant. Expenditures Expense Item AFHY Grant Dollars Source of funding Amount Explanation Ex. knives AFHY $60 Purchase of 4 kitchen $15 for preparing garden produce 1) AFHY 2) AFHY AFHY Request Total of funds requested of AFHY Other Cash Sources Ex. paper supplies 1) 2) 3) Store X donation $50 Gift card used for paper plates, plastic utensils, and napkins. Other Sources Subtotal Total Total of funds from other sources Other Resources/In Kind Estimated value of non-monetary sources What other resources such as spaces, services, people's time and other in-kind resources that will be used in the project? Briefly list. Example: Town playground for 50 hours - 1 hour day x 5 days/week x 10 weeks Recreation staff for 75 hours hours day x 5 days/week x 10 weeks

5 Sample Application This is just to give an idea of format and style. Note that the topic reflected was deliberately chosen to not relate to our funding focus. Please feel free to contact us if you have questions Sara Pelkey Section I: Applicant Information 1. Happy Youth, 10 Main Street, Cheshire NH John Doe Amount requested: $ Happy Youth is an afterschool program for grades K-3 in Cheshire, NH. We serve 30 youth from 25 families with an average daily attendance of 20. Hours are 3:00 to 6 PM Monday through Friday. Our mission is for Cheshire children to have a safe place afterschool that supports their classroom learning while enriching their lives through non-traditional subjects. 5. We are a Healthy Monadnock 2020 Organizational Champion. Section II: Project Description 1. Purpose: Our parents have expressed interest in having more musical activities. Because there are a number of studies that connect music to increased math ability, this fits into one of our program focuses. In looking at possible programs that were of high interest to youth, we found a good correlation between drumming programs and increased life skills and selfconfidence.(american Journal of Public Health, Apr 2003, Vol. 93, p 647.) The Cheshire Youth Drumming project has reported results in these areas and is an NH Council for the Arts approved program. 2. Impact: We anticipate 15 of our students from 12 different families participating in this pilot program. Participants will show improvement in both math skills and life skills including selfconfidence. 3. Actions: We will purchase two sets of drums and contract with Cheshire Youth Drumming to do a staff orientation and staff summary session and teach one session a week with youth participants and our participating staff for 9 weeks. Our staff will teach two other sessions a week modeling what they learned from Cheshire Youth Drumming. Our youth participants will do a performance once each quarter for their parents and the public tied into our quarterly program celebrations. 4. Timeline: When What Who Upon notification Purchase drum sets from Cheshire music and contract with Cheshire Youth Drumming for 2nd Quarter Director Jane December Initial staff training Cheshire Youth Drumming January 10 First session offered by Cheshire Youth Drumming Cheshire Youth Drumming Weekly Remainder of 9 Cheshire Youth Drumming sessions. Cheshire Youth

6 Drumming Weekly Two sessions a week offered by our trained staff. Site Coordinator Larry March First public performance by drumming troupe Director Jane March 19 Second series of drumming offered by our trained staff SC Larry June Post-pre student evaluations done Director Jane July 1 Report of results to AFHY and Board of Directors Director Jane 5. Evaluation: We will be in regular contact with classroom teachers to track math daily participation as well as student grades to see if there is better improvement with students in the drumming program as compared to students not participating in drumming. In addition, we will measure increases in life skills and self concept both through observations of staff and in comparing increases reported by students in the program versus not in the drumming program through our existing student beginning and end of year survey of life skills. We will share the results with our Board of Directors, in our parent newsletter and with AFHY and would be glad to discuss this program with any other groups who would like to implement it. 6. Diverse Representation: Our board of directors has representation from 8 different communities and has wholeheartedly supported this application. We have discussed this with our parent advisory group and they are excited about this opportunity. Section III: Engagement and Resources 1. Community: Our parents want musical opportunities for their children but don't have the resources to make that happen. They have requested more exposure to music in our program and we believe this will help meet that request while also helping us support our students' growth in academic achievement. Our program space has available separate classrooms so that students in the drumming program can learn while not distracting other students in the program. 2. Resources: Two staff members will participate in the train the trainer activities. Other musical equipment that the program owns will be utilized during our quarterly student presentations along with the drums. Staff will continue the program after the initial training quarter. We have two parents who are musicians who will come in at least 3 times during each quarter to observe and give us feedback on how we are implementing the use of the drums into our regular programming. Our performances each quarter will be advertised and open to the public. 3. Family Involvement: Families will be informed of the project both in a special letter as well as the description in our quarterly student options mailing. Families will be invited to observe the sessions and attend our drumming performances offered each quarter. Students will occasionally have take home activities that can expand their rhythm skills through activities that can be done with their family at home. We believe families will better understand the relationship between rhythm, patterns and math and will report observing that their student has gained more self confidence. Section IV: Recognizing that Change Takes Time

7 1. Continuation: When the pilot program is over Happy Youth will have drum sets and trained staff that will continue to implement drumming as part of our regular program offerings to students. We believe that this will be the beginning of an ongoing core program that will continue many years into the future. 2. Partnerships: We hope that the parents that have indicated support for this project will continue to be involved in both student practice sessions and student performances. The support of Keene Music with discounts for student used musical equipment has been promised to be continued. Section V: Budget Expenditures Expense Item AFHY Funds 1) Train the trainer Source of funding Amount Explanation AFHY $600 Two staff sessions and 9 one hour student sessions by Cheshire Youth Drumming 2)Drum Set AFHY $200 One set of 5 African drums from Keene Music at 20% discount AFHY Subtotal $800 Total of funds requested from AFHY Other Cash Sources 1)Drum Set Board Discretionary Fund 2) Printing Program funds Other Sources Subtotal $400 Total $1,200 $200 Second set of 5 African drums from Keene Music at 20% discount $200 Performance flyers, take home activities Other Resources 3 Staff members receiving 4 hours training plus 10 hours mentoring: 14 hours 3 staff members doing 2 sessions per week: 2 hrs x 10 weeks x 2 quarters x 3 staff =120 hrs Classroom for student program: 10 weeks x 1 hour = 10 hours Auditorium for 3rd & 4th quarter student performances: 2 x 2 hrs = 4 hours

8 AFHY Mini-Grant Report AFHY asks all organizations who received a mini-grant to submit one short report within 30 days of the end of their project but no later than October 1 of the school year following the receipt of the grant letting us know how the project went and sharing information that others might use if they want to replicate your project. AFHY wants this to be as easy as possible. You may submit a report via mail or to the AFHY Facilitator (spelkey@cheshire-med.com OR Sara Pelkey Court St, Keene, NH 03431) OR may do it via survey monkey using this link < Required Information # Youth Participants: male female Hours of direct programming: # adult participants Suggested Items While there is no required format for the report, the items below are suggestions for what to include. We are only looking for a brief (one to two page) summary, completion of our survey monkey template. Brief summary of what was done. Number of male and female youth benefitting from the project. What changes did you find in your participants? How was this measured? Did you meet your objectives? How do you know? Youth and/or family responses to or stories of their involvement in the project. Photographs or video of your project in action (this helps us obtain the funds we offer through the mini-grant program). Do you think components of the project will continue? Briefly explain. Lessons learned - what suggestions or tips would you give someone else who might want to replicate this project? Is there anything you would do differently?