WA AFHK Smart Snacks in School Mini Grants 2014

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* 1. School Contact Information
Primary Grant Contact Information (the person who will serve as key contact for this grant)

First Name:

Last Name:

Job Title:

School Name:

Email:

Alternate Email:

Phone Number:

Fax:

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* 2. Name of Applicant
If different from above, please provide contact information for the person submitting this application.

Name:

Job Title:

Email:

Phone Number:

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* 3. Provide the names of the following key individuals.
NOTE: By providing their names this indicates their buy-in and approval of your proposal and will fully support the grant activities and requirements, if funded.

Name of Principal/Administrator:

Name of Food Service Director:

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* 4. School Demographic Information

Percent Students Receiving Free and Reduced Lunch:

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* 5. Project Details (Summary):
In 100 words or less; brief description of project including project’s goal and objectives

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* 6. Problem statement (Why is the project is needed): max 500 characters

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* 7. Project description (What are the specific activities and reasons you chose this approach): max 500 characters

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* 8. Project Outcomes by June 30, 2014

Project Outcome #1

Project Outcome #2:

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* 9. Project Timeline: max 500 characters

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* 10. Evaluation: How you will measure if your objectives have been met? max 500 characters

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* 11. Sustainability: A brief description of any plans to sustain the project? max 500 characters

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* 12. Do you agree to provide names and contact information for your school team members, if awarded?

Yes

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* 13. Budget:
Please itemize below how you plan to use the grant funds to achieve the objective/s of this mini grant. Be specific. Grant funds may not be used for staffing or administrative costs.
Your proposed budget must not exceed the grant maximum of $1500.

Program supplies

Program supplies Justification:

Incentives, gifts, and awards

Incentives, gifts & awards Justification:

Evaluation

Evaluation Justification:

Printing and Copying (1st Semester):

Printing and Copying Justification:

Meeting/Event Costs

Meeting/Event Costs Justification:

Total Project Budget

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* 14. Success Story. max 500 characters

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* 15. Has your school received (or applied for) additional funding to address nutrition or physical activity?

Yes

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* 1. School Contact InformationPrimary Grant Contact Information (the person who will serve as key contact for this grant)

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* 2. Name of ApplicantIf different from above, please provide contact information for the person submitting this application.

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* 3. Provide the names of the following key individuals.NOTE: By providing their names this indicates their buy-in and approval of your proposal and will fully support the grant activities and requirements, if funded.

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* 4. School Demographic Information

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* 5. Project Details (Summary): In 100 words or less; brief description of project including project’s goal and objectives

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* 6. Problem statement (Why is the project is needed): max 500 characters

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* 7. Project description (What are the specific activities and reasons you chose this approach): max 500 characters

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* 8. Project Outcomes by June 30, 2014

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* 9. Project Timeline: max 500 characters

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* 10. Evaluation: How you will measure if your objectives have been met? max 500 characters

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* 11. Sustainability: A brief description of any plans to sustain the project? max 500 characters

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* 12. Do you agree to provide names and contact information for your school team members, if awarded?

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* 13. Budget:Please itemize below how you plan to use the grant funds to achieve the objective/s of this mini grant. Be specific. Grant funds may not be used for staffing or administrative costs.Your proposed budget must not exceed the grant maximum of $1500.

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* 14. Success Story. max 500 characters

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* 15. Has your school received (or applied for) additional funding to address nutrition or physical activity?

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* 16. Is there anything else Action for Healthy Kids should consider in reviewing your application? max 500 characters

* 1. School Contact Information
Primary Grant Contact Information (the person who will serve as key contact for this grant)

* 2. Name of Applicant
If different from above, please provide contact information for the person submitting this application.

* 3. Provide the names of the following key individuals.
NOTE: By providing their names this indicates their buy-in and approval of your proposal and will fully support the grant activities and requirements, if funded.

* 5. Project Details (Summary):
In 100 words or less; brief description of project including project’s goal and objectives

* 13. Budget:
Please itemize below how you plan to use the grant funds to achieve the objective/s of this mini grant. Be specific. Grant funds may not be used for staffing or administrative costs.
Your proposed budget must not exceed the grant maximum of $1500.