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PHIT America GO! Grant Application **APPLICATIONS DUE JUNE 1st** $1,000-$5,000 GO! Grants support sustainable, low- cost programs before, during, and after school that increase students’ physical activity minutes toward the nationally recommended 60 minutes per day. Funds can be utilized for high-quality programs, professional development and gear. A. APPLICANT AND CONTACT INFORMATION ("Champion" for this grant) First Name: Last Name: Primary role within the school (parent, teacher, administration, etc.): Email: Confirm Email: Phone:

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PHIT America GO! Grant Application**APPLICATIONS DUE JUNE 1st**

$1,000-$5,000 GO! Grants support sustainable, low-cost programs before, during, and after school that increase students’ physical activity minutes toward the nationally recommended 60 minutes per day. Funds can be utilized for high-quality programs, professional development and gear.

A. APPLICANT AND CONTACT INFORMATION("Champion" for this grant)

First Name:  

Last Name:  

Primary role within the school (parent, teacher, administration, etc.):

 

Email:  

Confirm Email:  

Phone:  

SECONDARY CONTACT INFORMATIONFirst Name:  

Last Name:  

Primary role within the school (parent, teacher, administration,  

etc.):

Email:  

Phone:  

How did you learn about the GO! Grants?Facebook

PHIT America

Let's Move! Active Schools

Word of Mouth

SHAPE Conference

Other, please specify... ______________________

B. SCHOOL INFORMATIONName of School:

 

School Federal ID #:  

Street Address: 

City: 

State: Alabama

Alaska

Arizona

Arkansas

California

Colorado

Connecticut

Delaware

District of Columbia

Florida

... 30 additional choices hidden ...

South Dakota

Tennessee

Texas

Utah

Vermont

Virginia

Washington

West Virginia

Wisconsin

Wyoming

Zip Code: 

Phone: 

School Website: 

Principal Contact InformationName of School Principal:  

Email:  

Confirm Email:  

Phone:  

Type of School (select all that apply):Elementary

Middle

Public

Charter

Student Enrollment

 

Is your school a Title 1 school? Yes

No

Demographic Breakdown(optional)

Male Female

Asian    

African-American    

Hispanic    

Native American    

White/Caucasian    

Other    

Age BreakdownMale Female

Age 3-4    

Age 5-7    

Age 8-10    

Age 11-13

   

Number of weeks per year your school meets (1-52):

 

What is the average number of hours a child is active per week at your school? (Combination of PE and recess)

 

Is your school registered as a Let’s Move! Active School?Yes

No

If “No”, all GO! Grant awardees will be required to make the initial step to sign up as a Let’s Move! Active School before receiving a grant. (https://www.letsmoveschools.org)

If your school is awarded a GO! Grant, to whom should the check be made out to? (must be school, school district or PTO/PTA)

 

C. PROJECT INFORMATION

Project Name:

 

Two-three sentence summary of project:

 

Is this a new project or an enhancement of an existing project? (see GO! Grant Guidelines at top right of page)

 

Was the project chosen from our list of resources or designed by your school?

Chosen from KIDS in the GAME's list of resources

Designed by my school

Will you subcontract with a non-profit organization or deliver the project yourselves?

Subcontract with a non-profit organization

Deliver the project ourselves

Nonprofit DetailsTax ID numbers may be found on nonprofit website.

Name  

EIN or tax ID Number  

Dates of projectFrom

____/__/__ (YYYY/MM/DD)

Dates of projectTo

____/__/__ (YYYY/MM/DD)

Requested GO! Grant amount:Please enter only numerical values

 

If we are unable to fulfill the requested amount, what is the minimum amount needed to ensure your program will occur?Please enter only numerical values

 

D. PROJECT DESCRIPTION (40 POINTS)**We encourage brief but clear answers that help give a strong narrative of your proposed project**

The student population you plan to serve, and why you are choosing this particular group:

 

Use the following bullet points to help guide the description of your project:Need or challenge your project addresses How your project will meet the challenge: describe your project and how it addresses the stated need, and

 

What objective performance measures will you use to determine positive changes in your students’ activity levels, fitness, commitment to continue activities?

 

Resources and tools you will use to structure and implement your project:

 

E. PROJECT ACTIVITIES (10 POINTS)**We encourage brief but clear answers that help give a strong narrative of your proposed project**

Estimated number of students involved in project:

 

Number of days per week the project will be offered:

 

Number of hours per week students will be active in the project:

 

Specific activities offered:

 

Facilities to be used:Will the school host the project or will it be hosted at a different location in the community?

 

Equipment needed for the project: (your school may be eligible to receive an equipment grant from our partner, Good Sports.)Please list general equipment needed and how it will be used for the project. In the Budget section, you will provide a detailed list for all equipment requested. 

 

F. PROJECT STAFFING (20 POINTS)**We encourage brief but clear answers that help give a strong narrative of your proposed project**

Who will help operate your project? Paid staff, volunteers, student aides? Why did you choose this particular staffing setup?

 

What training will be offered to project staff?

 

Use the following bullet points to help guide the description of your staffing plans:Who is your champion (project overseer and implementer)? Why was s/he chosen? If you are sub-contracting with a non-profit organization to implement your project, explain their missionand why you believe they can accomplish the goals of your project.

 

G. PROJECT SUSTAINABILITY: (15 points)How will you keep it going? How will you continue to monitor improved fitness levels among your students?  What are the plans to help fund the program in the future?

 

H. PROJECT BUDGET (15 points)Please use only numerical values. Do not include dollar sign ($), commas (,) or decimals (.00)

REVENUES

GO! Grant FundingAmount Requested:

 

Other Funds (optional)

Other grants  

Fundraisers, events, etc.  

Donations  

School allocation  

District allocation  

Other (specify amount)  

In-kind (estimate monetary value)

 

Total Revenue: If you receive an error message, make sure you have only entered numerical values above.

 

EXPENSES**GO! Grant funds cannot be used for staff salaries or administrative & office supplies. The total GO! Grant expenses should add up to the amount you are requesting at the top of this page.**

GO! Grant Funds Other Funds

Staff    

Professional Development    

Marketing/Outreach    

Gear & Sports Equipment    

Facilities    

Transportation    

Programming & Fees    

Sub-contracting costs (not included above)

   

Other    

Total Expenses:If you receive an error message, make sure you have only entered numerical values above.

 

If you have requested gear as part of your proposal, please share the purpose of the request. (Your response will help us with reporting to the sponsors providing gear.)

 

Budget SummaryPlease review that your Total Revenues equal your Total Expenses. If they don't, go back to the previous page and update.

Total Revenue:

 

Total Expenses:

 

Hidden Value

 

GO! Grant Equipment ListPlease only list gear and equipment that will be used to promote physical activity. Do not list any administrative or office supplies such as paper or pencils.

#1Item # Requested Price per unit Total Cost Description (i.e.

brand, size, color, etc.)

Basketballs

Footballs

Soccer balls

Volleyballs

Kickballs

Dodge balls

       

Medicine balls

Kettle balls

Tennis balls

Baseballs

... 2 additional choices hidden ...

Jump ropes

Hula Hoops

Frisbees

Pedometers

Heart rate monitors

Yoga mats

Equipment packs 

Exercise bands

Mini Hurdles

Agility ladders

#2Item # Requested Price per unit Total Cost Description (i.e.

brand, size, color, etc.)

Basketballs

Footballs

Soccer balls

Volleyballs

Kickballs

Dodge balls

Medicine balls

Kettle balls

Tennis balls

Baseballs

... 2 additional choices hidden ...

Jump ropes

Hula Hoops

Frisbees

Pedomet

       

ers

Heart rate monitors

Yoga mats

Equipment packs 

Exercise bands

Mini Hurdles

Agility ladders

#3Item # Requested Price per unit Total Cost Description (i.e.

brand, size, color, etc.)

Basketballs

Footballs

Soccer balls

Volleyballs

Kickballs

Dodge balls

Medicine balls

Kettle

       

balls

Tennis balls

Baseballs

... 2 additional choices hidden ...

Jump ropes

Hula Hoops

Frisbees

Pedometers

Heart rate monitors

Yoga mats

Equipment packs 

Exercise bands

Mini Hurdles

Agility ladders

#4Item # Requested Price per unit Total Cost Description (i.e.

brand, size,

color, etc.)

Basketballs

Footballs

Soccer balls

Volleyballs

Kickballs

Dodge balls

Medicine balls

Kettle balls

Tennis balls

Baseballs

... 2 additional choices hidden ...

Jump ropes

Hula Hoops

Frisbees

Pedometers

Heart rate monitor

       

s

Yoga mats

Equipment packs 

Exercise bands

Mini Hurdles

Agility ladders

#5Item # Requested Price per unit Total Cost Description (i.e.

brand, size, color, etc.)

Basketballs

Footballs

Soccer balls

Volleyballs

Kickballs

Dodge balls

Medicine balls

Kettle balls

Tennis balls

       

Baseballs

... 2 additional choices hidden ...

Jump ropes

Hula Hoops

Frisbees

Pedometers

Heart rate monitors

Yoga mats

Equipment packs 

Exercise bands

Mini Hurdles

Agility ladders

#6Item # Requested Price per unit Total Cost Description (i.e.

brand, size, color, etc.)

Basketb        

alls

Footballs

Soccer balls

Volleyballs

Kickballs

Dodge balls

Medicine balls

Kettle balls

Tennis balls

Baseballs

... 2 additional choices hidden ...

Jump ropes

Hula Hoops

Frisbees

Pedometers

Heart rate monitors

Yoga mats

Equipment packs 

Exercise bands

Mini Hurdles

Agility ladders

#7Item # Requested Price per unit Total Cost Description (i.e.

brand, size, color, etc.)

Basketballs

Footballs

Soccer balls

Volleyballs

Kickballs

Dodge balls

Medicine balls

Kettle balls

Tennis balls

Baseballs

       

... 2 additional choices hidden ...

Jump ropes

Hula Hoops

Frisbees

Pedometers

Heart rate monitors

Yoga mats

Equipment packs 

Exercise bands

Mini Hurdles

Agility ladders

#8Item # Requested Price per unit Total Cost Description (i.e.

brand, size, color, etc.)

Basketballs

Football

       

s

Soccer balls

Volleyballs

Kickballs

Dodge balls

Medicine balls

Kettle balls

Tennis balls

Baseballs

... 2 additional choices hidden ...

Jump ropes

Hula Hoops

Frisbees

Pedometers

Heart rate monitors

Yoga mats

Equipment packs 

Exercise bands

Mini Hurdles

Agility ladders

#9Item # Requested Price per unit Total Cost Description (i.e.

brand, size, color, etc.)

Basketballs

Footballs

Soccer balls

Volleyballs

Kickballs

Dodge balls

Medicine balls

Kettle balls

Tennis balls

Baseballs

... 2 addition

       

al choices hidden ...

Jump ropes

Hula Hoops

Frisbees

Pedometers

Heart rate monitors

Yoga mats

Equipment packs 

Exercise bands

Mini Hurdles

Agility ladders

#10Item # Requested Price per unit Total Cost Description (i.e.

brand, size, color, etc.)

Basketballs

Footballs

Soccer

       

balls

Volleyballs

Kickballs

Dodge balls

Medicine balls

Kettle balls

Tennis balls

Baseballs

... 2 additional choices hidden ...

Jump ropes

Hula Hoops

Frisbees

Pedometers

Heart rate monitors

Yoga mats

Equipment packs 

Exercise bands

Mini Hurdles

Agility ladders

If your equipment request is not included on the drop down menu above, please include it here. Also list any additional equipment requests beyond those listed above. Please include description, quantity, and cost.

 

Thank you for submitting your application and for your commitment to increasing physical activity among students at your school. We are in the process of receiving applications through June 1, and will determine which schools will receive grant awards by the end of July. Please feel free to visit our Resources page to continue learning about successful programs and find opportunities for additional funding.