2018-2019 School Grants for Healthy Kids School Breakfast Start Up Grant Application for Funds Download and print the School Breakfast Application Guide for an outline on the steps to submitting an application, a more detailed description of the application requirements and needs around each question. Section 1: Grant Contact Information 1. Applicant Contact Information a. Role (Select one) Community Based / Nonprofit Organization Staff Community Member Government Official / Agency Staff Health Professional Parent School Professional-Administrator Professional-Board Member School Professional-Food Service School Professional-Higher Ed School Professional-Nurse/Health Aid School Professional-P.E. Teacher School Professional-Teacher School Professional-Other Student None of the Above b. Phone Number c. Email d. Alternate Email 2. By providing the names of the following key individuals below you indicate their support and approval for the proposed project. a. Name of Principal/Administrator (if different from the person completing the application) b. Email: c. Name of District Food Service Director (if different from the person completing the application)
d. Email: e. Name of School Building Food Service Manager (if different from the person completing the application) f. Email: Section 2: School Project Data 3. Are you applying for more than 1 school building to receive funding? Yes No If yes, how many schools? 4. ADP for School Meals: Please enter your school s data from October 2017 for the questions below. Total lunches/breakfasts: includes free, reduced and paid meals Day of service: how many days of service for October 2017 Enrollment: total # of students enrolled in the school Average Attendance: total # of students attending school October 2017 (if your school reports as a percentage please multiply the percent by enrollment to get # of students) a. Total Lunches served (October 2017) b. Total breakfast served (October 2017) c. Days of service d. Enrollment e. Average Daily Attendance Free and Reduced % for school (if CEP, enter 100), (i.e. 85% = 85) 5. Please indicate your current breakfast model (Select one): Traditional Breakfast (Students pick up and eat in the cafeteria before the start of the school day) Alternative Breakfast in the Classroom (Breakfast delivery to classroom) Alternative Grab and Go to Classroom (Breakfast picked up from locations in school (other than cafeteria) and taken to classroom to eat) Alternative Grab and Go to Other locations (Breakfast picked up from locations in school and eaten in other areas of the school (not in the classroom or in the cafeteria)) Alternative Second Chance (Breakfast offered after 1 st period or at another time in day from locations around the school or from the cafeteria) Other: Describe 6. Does your school currently offer all students breakfast at no charge? Yes, through participation in Community Eligibility Provision Yes No
7. Please indicate below which alternative breakfast model will be used to drive increased participation in school breakfast. (Select one) Alternative Breakfast in the Classroom (Breakfast delivery to classroom) Alternative Grab and Go to Classroom (Breakfast picked up from locations in school (other than cafeteria) and taken to classroom to eat) Alternative Grab and Go to Other locations (Breakfast picked up from an alternate location and taken to other locations within the school (not in the classroom or cafeteria)) Alternative Second Chance (Breakfast offered after 1 st period or at another time in day; could be offered via locations throughout the school or in cafeteria) Other: Describe 8. Will your school offer all students breakfast at no charge in the 2018-2019 school year? Yes, through participation in Community Eligibility Provision Yes No 9. Do students have permission to eat breakfast in their classroom or homeroom/first period class after the bell? Yes, students are already eating breakfast in their classroom and will continue next year. Yes, the principal has agreed to allow students to eat in the classroom next year. We re working on buy-in from the principal to eat in the classroom but it hasn t been agreed on yet. No, we will not be allowing students to eat anywhere but in the cafeteria. Other: Students will be eating in another location, not in the classroom or cafeteria: (Identify location) 10. Schools with principal support have more success in implementing proposed changes to the breakfast program. Please indicate where your school is in securing principal support for your proposed breakfast project. Principal has requested the new breakfast programming. Child nutrition/food service has engaged and secured the principal s agreement. Child nutrition/food service is in communication with the principal, but full agreement is not currently in place. Child nutrition/food service hasn t engaged principal yet. 11. Identify the grade levels that receive nutrition education. (Check all that apply) Our school doesn t provide nutrition education K 1 2 3 4 5 6 7 8
9 10 11 12 Section 3: Project Summary 12. Describe in detail the breakfast project you wish to incorporate at your school to increase breakfast participation. Action for Healthy Kids is looking for utilization of best practices that lead to the greatest impact on policy, systems, and environmental changes and thus, on student health and academic achievement. (2000 characters). 13. Project Timeline Please describe your tentative project timeline. Tell us what you hope to accomplish in each month of the grant term (July 2018 through May 2019). NOTE: Schools will receive grant funds in August 2018. (4000 characters) July 2018 August 2018 Sept 2018 Oct 2018 Nov 2018 Dec 2018 Jan 2019 Feb 2019 Mar 2019 April 2019 May 2019 14. Sustainability Once the grant term is over, describe how your school team will ensure the programs, policies, and practices developed and implemented as part of this grant will be sustained for, at least, the next 3 school years (through 2021-2022 school year). (2000 characters) 15. Will you be willing to share information on your breakfast programming for one year following grant funding (during the 2019-2020 school year)? Yes No Section 4: Budget 16. Please select how you plan to use the grant funds to achieve the objective/s of this mini grant. Grant funds may not be used for staffing or administrative costs, nor can funds be used for food, except for food for taste tests Start Up/Implementation Needs: Schools will receive either $2,000 or $3,000. Awards will be determined by need, current breakfast participation and project plans. (Check all that apply) Insulated bags for breakfast delivery to the classroom Kiosks/cart for grab and go mobile location Clean up supplies/trash cans
POS or key pads Marketing or incentives Taste tests for student/parent engagement Other equipment Other (Open ended) 17. Describe other funding your school has received (or applied for) to address school breakfast activity. (500 characters) Section 5: Other Information and Opportunities 18. During a typical year, how many times did your school health team meet? Our school does not have a school health team. 0 times 1 time 2 times 3 times 4 times or more 19. Which of the following groups are represented on your school health team? (Check all that apply) Administrators Food Service Staff School Health Professionals Physical Education Teachers Other Teachers Students Parents Community partners Our school does not have a school health team Other (Please specify): 20. How did you first hear about the School Grants for Healthy Kids grant opportunity? Action for Healthy Kids State Coordinator Partner website or communications (USDA, FRAC, Shape America, Let s Move, etc.) I am a previously funded school through School Grants for Healthy Kids Kellogg s Employee Referral Walmart Employee Referral Media (e.g. news article, blog) Other (Please specify) 21. Which of the following describes how often you access the online Game On program? I have never accessed the online program I accessed the online program, but not regularly (1-3 times or less) I accessed the online Game On program regularly (4+ times)
22. How satisfied are you with the services and resources AFHK has provided during this application process? Did not Use Not at All Satisfied Less Satisfied Satisfied Very Satisfied Extremely Satisfied o o Service Professionalism of state coordinator: Support via 1-800 phone line: Non-state coordinator email (e.g. schoolgrants@actionforhealthykid.org ) Grant Process School portal Application guide 23. If additional funding became available, would your school host a healthy breakfast taste test? Yes No 24. If additional funding became available, would your school host a family breakfast engagement event during the school year (such as a family breakfast, etc.)? Yes No 25. If additional funding became available, would your school host a nutrition promotional campaign during the school year? For example, campaign themes such as Rethink Your drink, MyPlate, etc. Yes No 26. Would your school be able and willing to host corporate volunteers for a school wellness event? Yes No Thank you for completing this paper application. Once satisfied, proceed to www.actionforhealthykids.org/grants to submit your application online. For questions please contact your designated AFHK State Coordinator or SchoolGrants@ActionforHealthyKids.org