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2025-2026 School Wellness Stipend Request Form

Please complete the form below to submit your request for a chance to have AtlantiCare Healthy Schools, Healthy Children support one of your school wellness related events.
  • Each school may receive 1 stipend per school year.
  • Schools may receive up to a $200 stipend to assist with any costs for the event, including event materials and prizes for winners.
  • Schools must submit a Stipend Report summarizing how funds were utilized along with 2 photos, due no later than 2 weeks after the event date in order to receive funding in the following school year.

All requests due by April 1, 2026.
1.School Name:(Required.)
2.School Address:(Required.)
3.Name of Person Completing Form:(Required.)
4.Email of Person Completing Form:(Required.)
5.Principal's Name:(Required.)
6.Principal's Email:(Required.)
7.Event Name:
(Required.)
8.Event Description:
(Required.)
9.Event Date:
(Required.)
10.Your school may request up to $200 to support your school wellness event. Please provide a budget breakdown of event expenses:(Required.)
11.Please select who this event will benefit (select all that apply):(Required.)
12.Please select the WSCC (Whole School, Whole Child, Whole Community) components that are present in your activity or event (select all that apply):
*Click here for more information.(Required.)
13.If your school is awarded funding to support a school wellness event, you must agree to the following:(Required.)
14.If awarded, please specify whom check should be made payable to, and include the mailing address. (Checks cannot be made payable to an individual.) Please consult with your administration to ensure convenient access to funds as needed.(Required.)
Once request is received, a Healthy Schools Team member will confirm receipt within 72 hours. If you do not receive a confirmation, please email a team member at healthyschools@atlanticare.org.