Exit this survey Office of Student Health and Wellness Partner Application 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 The Survey Monkey application is no longer active and is not monitored.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. Question Title * 1. Organization Name: Question Title * 2. Primary Contact: Question Title * 3. Primary Contact Phone: Question Title * 4. Primary Contact Email: Question Title * 5. Primary Address Question Title * 6. Secondary Contact Name: Question Title * 7. Secondary Contact Phone: Question Title * 8. Secondary Contact Email: Question Title * 9. Organization Mission Statement: Question Title * 10. What is the primary focus of your organization’s health and wellness programming? Nutrition Education Physical Activity/Fitness Urban Agriculture Health Education Sexual Health Education (including anatomy & physiology, puberty & adolescent development, identity, pregnancy & reproduction, sexually transmitted infections & HIV, healthy relationships or personal safety) Asthma Allergies Diabetes Oral Health Culinary Arts Other (please specify) Question Title * 11. Please indicate your organization's tax status: For profit Not for profit (501c3) Question Title * 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. Question Title * 13. How does your programming align with CPS/the district's policies and priorities? Question Title * 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: Question Title * 15. During what time do you offer programming to schools? Check all that apply. Before School During the School Day After School Question Title * 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. Yes No Question Title * 17. Are your services free to schools? Yes No If no, please describe cost structure and fees required. Question Title * 18. Has your organization offered services to CPS schools in the past? Yes No Question Title * 19. Please provide your CPS vendor number (if applicable) Question Title * 20. Did your organization provide services/programming to Chicago Public Schools in SY 2016-2017? Yes, we provided services/programs to schools during the past school year (SY 2016-2017) No, we hope to provide services/programs to schools beginning next school year (SY 2017-2018) Question Title * 21. If yes, please list the schools in which your organization currently provides services and describe the services provided in the space below. Question Title * 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.) Question Title * 23. Are you currently working with other CPS Departments? Yes No Question Title * 24. If applicable, did your organization complete the CPS Out of School Time Request for Proposal (OST RFP)? Yes No Question Title * 25. How many CPS schools does your organizations have the capacity to work with this year? Question Title * 26. Have you already identified all the schools with which your organization will work with this school year? Yes No Question Title * 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: December 13, 2017 11:00 am - 11:30am Sexual Health ONLY Jan. 17, 2018 9:15 am - 9:45 am (health and wellness - non-sexual health) Jan. 17, 2018 10:00 am - 10:30 am (health and wellness - non-sexual health) Jan. 17, 2018 10:45 am - 11:15 am (health and wellness - non-sexual health) Next