Skip to content
Prevention and Wellness Academy of Ohio
Participant Application
*
1.
Contact information for person submitting the application (name, title/role, email, phone number, School district and school building you are submitting for) If chosen, this will be the person contacted about application acceptance and next steps, including identifying the districts team lead.
(Required.)
Name:
Title/Role
Email
Phone Number
School District
*
2.
What is your district’s enrollment?
(Required.)
*
3.
To participate in this academy, you will need to identify a team of at least five (minimum) personnel but up to seven personnel, this team should include at least one person in each of the following roles:
School district administrator (e.g., assistant superintendent, principial, assistant principal, director of student services)
Guidance counselor, school psychologist, school social worker, or other student support staff
Teacher
Is your school/district willing to have a team in place by October 2022?
(Required.)
Yes
No
*
4.
Does your school district participate in a student behavior survey? Examples: OHYes, Youth Risk Behavior Survey (YRBS), Pride Survey
(Required.)
Yes
No
Other (please specify)
*
5.
If your school district does not participate in a student behavior survey, will your district commit to doing one of the surveys named in the above question and share results with the Academy?
(Required.)
Yes
No
Other (please specify)
*
6.
Please briefly describe in 100 words or less why you want to participate in this academy:
(Required.)
*
7.
There is a level of commitment needed to participate in the Prevention and Wellness Academy Needs Assessments.
Have you read the commitment form?
(Required.)
Yes
No
*
8.
Is your school district prepared to fulfill the commitments?
(Required.)
Yes
No
Other (please specify)
*
9.
Is your Superintendent or lead district administrator (if not the person completing the application) prepared to sign off on the commitments
(Required.)
Yes
No
Other (please specify)
Thank you for your application as a participant in the Prevention & Wellness Academy of Ohio. Approved applications will be announced to participants by EOB October 25th, 2022
