Exit this survey

The CPS Office of Student Health and Wellness (OSHW) invites you to submit an application to the Health and Wellness Materials Review Committee for consideration.  Please select this LINK to submit your Health and Wellness Materials Review Committee application. The Survey Monkey application is no longer active and is not monitored. Survey Monkey applications will not be reviewed. 

Please email the Office of Student Health and Wellness at  OSHW@cps.edu  if there are any questions or concerns.

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* 1. Organization Name:

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* 2. Primary Contact:

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* 3. Primary Contact Phone:

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* 4. Primary Contact Email:

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* 5. Primary Address

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* 6. Secondary Contact Name:

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* 7. Secondary Contact Phone:

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* 8. Secondary Contact Email:

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* 9. Organization Mission Statement:

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* 10. What is the primary focus of your organization’s health and wellness programming?

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* 11. Please indicate your organization's tax status:

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* 12. Provide a brief description of the program, materials or curriculum. This will be used in communication materials to schools. Please limit your description to 5 sentences.

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* 13. How does your programming align with CPS/the district's policies and priorities?

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* 14. Describe in detail the services, resources and programs available to schools. Include the duration (how many weeks/school year, how many days/week, and hours/day of service) program goals and activities:

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* 15. During what time do you offer programming to schools? Check all that apply.

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* 16. Does your programming utilize a written curriculum or educational materials distributed to students? If yes, please submit via email to oshw@cps.edu (preferred) SUBJECT LINE: Materials Review Committee Submission.

If electronic is not available please mail a copy of your curriculum to: Chicago Public Schools, Office of Student Health and Wellness, Attn: Materials Review Committee 42 W Madison, Garden Level, Chicago, IL, 60602.

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* 17. Are your services free to schools?

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* 18. Has your organization offered services to CPS schools in the past?

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* 19. Please provide your CPS vendor number (if applicable)

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* 20. Did your organization provide services/programming to Chicago Public Schools in SY 2016-2017?

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* 21. If yes, please list the schools in which your organization currently provides services and describe the services provided in the space below.

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* 22. Does your organization provide workshops, trainings and professional development opportunities? If so, please provide a brief description, including dates, locations and other pertinent information. (This will be used to more accurately promote your events to our schools, staff and students.)

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* 23. Are you currently working with other CPS Departments?

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* 24. If applicable, did your organization complete the CPS Out of School Time Request for Proposal (OST RFP)?

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* 25. How many CPS schools does your organizations have the capacity to work with this year?

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* 26. Have you already identified all the schools with which your organization will work with this school year?

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* 27. Once your material is vetted by our department we will officially schedule a meeting with you to present your curriculum to the Materials Review Committee. Presentations are a total of 30 minutes per organization. Please indicate the date and time for   which you are available:

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