Introduction

The purpose of the HEAL Recognition Program and its levels of membership – Bronze, Silver, Gold and Platinum -- is to recognize and motivate local governments’ continued achievement from passing a HEAL resolution to attaining its HEAL goals.

To apply for a new recognition level, please complete this application by Monday, September 10th to be recognized at the upcoming Virginia Municipal League annual conference (September 30th - October 2nd). If you are applying to become a NEW HEAL city/town please send in your application earlier -- by Tuesday, September 4th – we may need more time to follow up with you before the conference!

All applicants are required to fill out the appropriate part of Section 1 (related to the level you are applying for) AND Section 2.
Recognition Level Descriptions
Platinum – Gold Level attained and evidence that HEAL policies and practices are integrated across municipal departments and are being monitored
Gold – three new HEAL strategies/goals are achieved
Silver – two new HEAL strategies/goals are achieved
Bronze –one new HEAL strategy/goal is achieved

Please note: You may exit and return to this survey by using the survey link. Your answers will be remembered and saved by your device's browser. Make sure you return to the survey using the same device to access your work. 
Please be sure to:

(1)  Answer the questions in Section One that relate to the recognition level you are applying for and
(2)  Answer all the questions in Section Two.

Please be as complete as possible so as not to hold up the application process.

If you have applied in the past, you will notice some changes to the application. We have tried to streamline the process, listening to your suggestions and respecting your time. We continue to appreciate your feedback, and it is welcome at the end of the form!

IMPORTANT NOTE: This application is intended to capture information about and recognize your city’s/town’s work and accomplishments related to healthy eating and active living. We recognize the various ways in which a city can realize the goals associated with the HEAL Resolution.  The four primary means are through:

1)    Passing or adopting a law, policy, or ordinance. 

Some examples include:

·   Incorporating health or wellness language in the General or Comprehensive Plan (e.g., including a health element/chapter)
·   Passing an ordinance that requires that 50% of snacks offered in municipal vending machines meet nutritional standards
·   Adopting a complete streets policy

2) Implementing or administering a new or enhanced service or program. 

Some examples include:

·   Establishing a workplace wellness fitness program for municipal employees
·   Creating an opportunity for municipal employees to purchase a selection of affordable, fresh produce from local farmers through a CSA (Community Supported Agriculture) program
·   Incorporating health and wellness goals and activities in a recreation program for seniors

3) Adopting, implementing, or changing a city practice and operation.

Some examples include:

·   Incorporating walking and stretch breaks in all staff meetings
·   Requiring that a vendor meets healthy vending nutritional standards as part of its contractual agreement with the city
·   Establishing an interdepartmental committee to implement HEAL activities

4) Making an environmental improvement. 

Some examples include:

·   Establishing walking paths in the city with signage
·   Park improvements to encourage physical activity
·   Establishing or enhancing farmers’ markets or community gardens
PLEASE NOTE: Work you may have accomplished for the Green Government Challenge for Go Green Virginia or a similar program may also qualify for this application, if it is related to healthy eating or active living. Also, other work you have done related to healthy eating and active living can qualify for recognition, even if it is not listed as a goal in your HEAL resolution (i.e., for some cities and towns an opportunity to work on a healthy eating or active living issue arises that they did not know about when crafting their HEAL resolution).

If you have any questions about what to include in your application or any other questions about the application, please contact HEAL C&T Campaign Manager, Sydney Daigle at 864-373-4713 or sdaigle@institutephi.org.
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* 1. City/Town Name:

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* 2. Please check which designation best describes your city/town:

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* 3. What is your city/town population?

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* 4. Name of person completing the application:

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* 5. Title of person completing the application:

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* 6. E-mail address of person completing the application:

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* 7. Please select the recognition level for this application:

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