Law Enforcement Health & Wellness Scholarship Application

The National Center for the Prevention of Community Violence is a national nonprofit with extensive experience providing evidence-based programming aimed at interrupting the process of violence in communities. In response to increased strains due to COVID19, the NCPCV First Responder Wellness COVID Response Program uses an innovative approach to providing comprehensive, culturally competent training, education and tools to foster health and wellness of public safety personnel and their families.

This national initiative promotes wellness by integrating technology through use of mobile app and web portal platforms to provide our nation’s first responders and families confidential, anonymous access to culturally competent, cutting edge health/wellness information and resources.

In partnership with Lighthouse Health & Wellness, and funding from the Motorola Solutions Foundation, NCPCV is now offering 15 scholarships to law enforcement agencies across the nation.

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* 1. Agency Information

Name of the Agency

Address

Address 2

City/Town

State/Province

ZIP/Postal Code

Phone Number

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* 2. Person Completing the Application

Name of Person Completing the Application

Email Address

Phone Number

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* 3. Number of Sworn Personnel

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* 4. Please describe your agency's goals for meeting the health and wellness needs of your personnel.

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* 5. Please describe the health and wellness activities, programs or initiatives currently active in your department.

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* 6. Please describe your biggest challenge with implementing health and wellness activities, programs and/or initiatives within your department.

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* 7. On a scale of 1-5, rate how well your department is addressing the health and wellness needs of your personnel.

Not Well -Meeting No Needs

Minimally -Meeting Few Needs

Good -Meeting Most Needs

Very Well -Meeting Nearly All Needs

Excellent -Meeting All Needs

Not Well -Meeting No Needs

Minimally -Meeting Few Needs

Good -Meeting Most Needs

Very Well -Meeting Nearly All Needs

Excellent -Meeting All Needs

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* 8. On a scale of 1-5, rate how comprehensive your agency's wellness program is.

Not Comprehensive, No Current Program In Place

Minimally Comprehensive, Addresses 1-2 Areas of Wellness

Comprehensive, Addresses 3 Areas of Wellness

Very Comprehensive, Addresses More Than 3 Areas of Wellness

Fully Comprehensive, Addresses All Areas of Wellness

Not Comprehensive, No Current Program In Place

Minimally Comprehensive, Addresses 1-2 Areas of Wellness

Comprehensive, Addresses 3 Areas of Wellness

Very Comprehensive, Addresses More Than 3 Areas of Wellness

Fully Comprehensive, Addresses All Areas of Wellness

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* 9. On a scale of 1-5, what level of impact are your department's current health and wellness activities, programs and/or initiatives having on your personnel?

No Impact

Mild Impact

Moderate Impact

Notable Impact

Profound Impact

No Impact

Mild Impact

Moderate Impact

Notable Impact

Profound Impact

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* 10. On a scale of 1-5, how satisfied do you think your personnel are with the current level of health and wellness activities, programs and/or initiatives in your department?

Not Satisfied

Minimally Satisfied

Satisfied

Very Satisfied

Completely Satisfied

Not Satisfied

Minimally Satisfied

Satisfied

Very Satisfied

Completely Satisfied

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* 11. On a scale of 1-5, rate the impact you anticipate with the implementation the NCPCV/Lighthouse H&W Wellness Mobile App and Web-portal program.

There Will Be No Impact

Minimally Impacted

Impacted

Very Impacted

Profoundly Impacted

There Will Be No Impact

Minimally Impacted

Impacted

Very Impacted

Profoundly Impacted

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* 12. Please indicate below your agreement should your agency be selected to receive a scholarship.

We understand that the scholarships are sponsored by an outside funding source and agree to work with NCPCV to ensure that proper documentation is managed.

We agree to actively participate in the on-boarding process with project partners to ensure timely program implementation within 45 days of the start of the on-boarding process.

We agree to complete all program surveys within the requested time frame.

We agree to work with NCPCV to develop a plan for sustaining the program beyond the scholarship period.

We understand that this scholarship is for a service and there will be no actual monetary exchange between our agency and NCPCV.

We understand that the length of the scholarship is for 12 months of Lighthouse programming and NCPCV makes no financial commitment to program costs beyond this designated 12 month period.

We understand that once a scholarship is offered to our agency that we may decline to accept the scholarship.