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2025-2026 Staff Professional Development Request Form
Please fill out the form to request a staff professional development session.
Deadline for requests: May 1, 2026
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1.
School Name:
(Required.)
*
2.
School Address:
(Required.)
*
3.
Name of Person Completing Form:
(Required.)
*
4.
Email of Person Completing Form:
(Required.)
*
5.
Alternate
Contact Person:
(Back up person just in case you are absent the day of event.)
(Required.)
*
6.
Alternate Contact Email:
(Required.)
Please provide an estimate of the demographics of staff participating in the activity:
*
7.
Provide an estimated percentage:
(Required.)
Male
Female
Other
*
8.
Provide an estimated percentage:
(Required.)
American Indian or Alaska Native
Asian or Asian American
Black or African American
Hispanic or Latino
Middle Eastern or North African
Native Hawaiian or other Pacific Islander
White
Another race
*
9.
Age Group:
(Required.)
18-24
25-34
35-44
45-54
55-64
65+
*
10.
Number of Staff:
(Required.)
*
11.
Room Type/Location:
(Required.)
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12.
Choose from the following:
(Required.)
Presentation:
Choose from one of our Healthy Schools
presentations
made with school staff and communities in mind.
Yoga or Zumba Class:
A traditional yoga or Zumba class led by a certified teacher from our AtlantiCare LifeCenter.
Stretching Class:
This class will take staff through a whole body stretch as well as stretches to do right from your desk chair in your classroom.
Art Therapy:
Introduce staff to another form of stress management led by our partners at Mindfully Active.
Tanita Scale:
A Healthy Schools Team member will visit your school with our Tanita Scale for body composition analysis.
Wellness Tea Party:
Promote mindfulness and staff connections over tea and stations such as essential oils, adult coloring, and breathing exercises.
Values & Self-Esteem:
Activities to promote self-reflection to bring forward strengths and goals for the future.
Wellness Team Workshop:
A Healthy Schools Team member will visit your school to work with staff on establishing and/or maintaining a school wellness committee.
Special Request:
Have a different workshop/topic/activity in mind? Describe below.
*
13.
Special Request Description/Idea:
(Required.)
*
14.
Requested Date(s):
(Please be as specific as possible to assist with scheduling and list multiple date options. Requests must be made at least 3 weeks in advance.)
(Required.)
*
15.
Requested Time(s):
(Please note ideal start & end times.)
(Required.)
*
16.
How many sessions would you like to have on this date?
(Required.)
*
17.
To celebrate AtlantiCare's ongoing partnership with area schools we would like to take photos/videos throughout the event. In preparation, all students and staff participating are requested to return a signed AtlantiCare photo/media release.
*All staff will be allowed to participate in any AtlantiCare activity no matter their approval or disapproval in completing this form.
(Required.)
By checking this box you confirm you have received permission from your administration for photos and videos.
Thank you for submitting this request. An AtlantiCare Healthy Schools Team member will contact you within 72 hours to discuss the availability of our team and to schedule this activity.
