APPLICATION IS DUE by 5 PM MST on February 9, 2021.

Thank you for your interest in the Healthy Minds Partnership Technical Assistance Award. Please apply by completing the application below.

It is recommended you type responses in another document, then copy and paste your responses into the appropriate fields. The application should take around 30 minutes to complete. 

Contact Blue Cross of Idaho Foundation for Health Program Officer Connor Sheldon at csheldon@bcidahofoundation.org with any questions.

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* 1. School District

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* 2. Superintendent

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* 3. School Name (each school needs to complete an application)

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* 4. Name (person filling out this form)

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* 5. Position/Title (person filling out this form)

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* 6. Email Address (person filling out this form)

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* 7. Phone Number (person filling out this form)

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* 8. Has your school identified available office or classroom space for this type of partnership? (Space can be near school counselors and/or office administration. Space should not be in secluded area of the building.)

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* 9. All Healthy Minds Partnership Technical Assistance Award application finalists must be willing to participate in a one-hour, videoconference interview with Blue Cross of Idaho Foundation for Health staff. Will you be able to accommodate for a one-hour videoconference interview the week of February 22-26, 2021? School district superintendent or assistant superintendent, school principal, school counselor, and other individuals should be available during this time.

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* 10. Please share why behavioral health is important to your school.

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* 11. Describe the evidence or available data to support the need to bring behavioral health services into your school. (Examples of data may include attendance, behavioral disruptions, etc.)

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* 12. How many students are enrolled at your school?

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* 13. What percentage of students at your school are eligible for free and reduced lunch?

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* 14. Provide a brief description of the demographics and unique needs of your student population.

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* 15. What behavioral health agencies/providers/federally qualified health centers (FQHCs) does your school currently refer to?

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* 16. Describe community partnerships between your school and external organizations.

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* 17. What type of support do you think would be most helpful to your school in developing the Healthy Minds Partnership? (Please select your top three priorities.)

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* 18. Traditionally there is a school champion (school counselor, principal, special education director, etc.) who acts as the primary point of contact for the duration of the Healthy Minds Partnership Technical Assistance Award. If you have a Healthy Minds Partnership program champion identified, please list their:

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* 19. Can leadership, staff, and the identified champion commit to spending around 5 hours per month from March-July to establish a school-located behavioral health partnership and complete the Healthy Minds Partnership Technical Assistance Award?

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