Sprouting Healthy Kids Childcare and School Garden Grant Application Survey

Security Health Plan and the Wood County Health Department believe in improving the health, lifestyles and overall well-being of the communities we serve. As part of our commitment, we are supporting childcare center and school gardens to help children increase vegetable consumption and develop healthy habits.

IMPORTANT: This application needs to be completed in one sitting, and will take about 20-30 minutes depending on your responses. You are able to go back to previous pages in the application and update existing responses until the application is finished or until you exit the survey. After the application is finished, you will not be able to re-access the application.

If you have questions, please feel free to contact Allison Machtan, Security Health Plan Health Educator at (715) 221-9872 or via email at machtan.allison@securityhealth.org OR Kristie Rauter, Wood County Community Health Improvement Planner at (715) 421-8915 or via email at krauter@co.wood.wi.us.

Question Title

* 1. Organization demographics

Organization: *

Address: *

City/Town: *

State: *

ZIP: *

Web site:

Fax number:

Phone Number:

Question Title

* 2. What best describes the organization?

Certified family childcare

Licensed family childcare

Licensed group center or preschool

Nonprofit K-12 school

501(c)(3)

Question Title

* 3. Point of Contact information

Name: *

Title:

Email Address: *

Phone Number: *

Question Title

* 4. Indicate the number of children from each age group who will actively participate in the garden program.

Ages 5 and under (preschool - K)

Ages 6-8 (grades 1-3)

Ages 9+ (grades 4 and up)

Question Title

* 5. Does the organization have a wellness policy? Check the topics addressed in the policy.

Nutrition

Support of vegetable gardens

Nutrition curriculum

Question Title

* 6. List partners included in this project. (Example: local health department, UW-Extension, etc.) If no partnerships currently in place, please explain how creating these partnerships may benefit your garden program.

Question Title

* 7. Which of the following best describes your garden project:

New garden

Improving an existing garden

Other (please specify)

Question Title

* 8. Describe the garden design, including type of garden (example: in ground vs. raised beds), square footage, distance of the garden from the organization and what produce you plan to grow.

Question Title

* 9. How will the produce grown in the garden be used?

Question Title

* 10. How will children be involved in the garden project?

Question Title

* 11. How will the garden be used to enhance curriculum?

Question Title

* 12. How will the garden project be sustained in the future?

Question Title

* 13. Which level of funding is the organization applying for?

Up to $500 (Example: expansion of existing garden, purchase of equipment to improve garden)

Up to $2,500 (Smaller garden project. Example: in ground garden bed)

Up to $5,000 (Larger garden project. Example: fenced area, raised beds with sides and a garden shed)

Question Title

* 14. Provide a proposed budget. Include a description of items and cost associated with each item. Examples of acceptable use of funding: dirt, mulch, fertilizer, seeds (no flowers), deer fence, water/rain barrels, garden tools, rental of rototiller, and generally no more than 30% of funding to be used for purchase of a garden shed.