The survey below MUST be submitted if your school is applying for a 2025-2026 AtlantiCare Healthy Schools, Healthy Children grant funding opportunity. Print out this worksheet and fill out with your School Wellness Committee or Team prior to filling out this online form.

Thank you in advance for collaborating with your peers and administration for the best answers to the questions. For clarification of any of the survey questions please contact a Healthy Schools team member at: healthyschools@atlanticare.org.

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* 1. School/Contact Information:

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* 2. How did you complete this survey? Check all that apply.

School Wellness Policies

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* 3. Does your school have its Wellness Policy easily accessible by staff & parents listed on your district's/school's website?

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* 4. Has your school ever used the Center for Disease Control's School Health Index to assess your school's health & wellness related policies, activities and programs?

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* 5. Your School Wellness Team or Committee meets:

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* 6. Is at least one parent/guardian an active member of your school's Wellness Committee/Team?

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* 7. Is at least one student an active member of your school's Wellness Committee/Team?

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* 8. During the past year, has any school health and wellness committee or team done any of the following activities? Check all that apply.

Physical Education & Physical Activity

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* 9. During the school year did Physical Education in your school incorporate the following topics? Check all that apply.

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* 10. Outside of physical education, do students participate in physical activity breaks and/or is physical activity integrated into classroom instruction during the school day? (ex. structured recess; walking club; movement associated with academic lessons, brain breaks)

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* 11. MIDDLE AND HIGH SCHOOL ONLY
Does your school offer opportunities for students to participate in physical activity before the school day?

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* 12. MIDDLE AND HIGH SCHOOL ONLY
Does your school offer after school sports or wellness related teams/clubs?

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* 13. A Joint Use Agreement is a formal agreement between a school/school district and another public or private entity to jointly use either school facilities or community facilities to share costs and responsibilities. Does your school, either directly or through the school district, have a Joint Use Agreement for shared use of school or community physical activity facilities (ex. township or municipal recreational programs, senior groups)

Health Education

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* 14. ELEMENTARY SCHOOL ONLY
During the school year has your staff tried to increase student knowledge on each of the following topics? Check all that apply.

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* 15. MIDDLE & HIGH SCHOOL ONLY
During the school year has your staff tried to increase student knowledge on each of the following topics?

Nutrition - Environment & Services

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* 16. During the school year did staff in your school teach students on the following topics? Check all that apply.

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* 17. During the school year has your school done any of the following?

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* 18. Are students encouraged and permitted to have a drinking water bottle with them during the school day?

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* 19. On average are 25% of eligible students eating school breakfast daily?

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* 20. Does your school have a policy regarding foods that can be provided for school/classroom celebrations?

Health Services

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* 21. Is your school a designated Asthma Friendly School?

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* 22. Does your school and/or school nurse provide parents with information on pediatrics/primary care services and/or health care insurance to students and families?

School Counseling, Psychology and Social Services

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* 23. Your school employs a full time:
Check all that apply.

Family Engagement

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* 24. During the school year did your school provide parents/families with health information designed to increase parent/family knowledge of the following topics? Check all that apply.

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* 25. During the school year has your school done any of the following activities? Check all that apply.

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* 26. Have teachers given students homework assignments or health education activities to do at home with their parents/families?

Collaboration and Community Involvement

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* 27. During the school year, has your Health/PE and/or School Nurse staff worked with any of the following groups within the school on health/wellness activities? Check all that apply.

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* 28. During the school year, has your school counselor, social worker and/or psychologist worked with any of the following groups within the school on health/wellness activities? Check all that apply.

School Employee Wellness

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* 29. Has staff conducted or participated in a culture & climate survey?

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* 30. What wellness resources are available to school staff during the year?

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