SCHOOL HEALTH PROFILE FORM
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1 SCHOOL HEALTH PROFILE FORM Healthy Schools Act of 2010 Under Section 602 of the Healthy Schools Act of 2010 (L ), each public school and public charter school within the District of Columbia is required to complete and submit the School Health Profile (SHP) form to the Office of the State Superintendent of Education (OSSE) on or before February 15 th of each year. Schools are also required to post the information requested in this School Health Profile form online, if the school has a website, and make the information available to parents in the main office. Any public school or public charter school that fails to complete and submit its School Health Profile form to OSSE on or before February 15 th of each year will be out of compliance with Section 602 of the Healthy Schools Act of 2010.
2 SCHOOL HEALTH PROFILE FORM Section 1: School Profile Section 1: School Profile 1. Type of School * Public School Public Charter School Private School 2. LEA ID: 3. School Code: 4. Ward: a. LEA Name* 5b. School Name* District of Columbia Public Schools Ellington School of the Arts 6. Does your school currently have a website?* 7. Current number of students enrolled* 520 6a. What is your school s website address? 8. Grades Served * PS PK K Adult Other 9a. Contact Name* 9b. Contact * 9c. Contact Job Title* Desepe de Vargas desepe.devargas@dc.gov Principal OSSE will contact this person if there are questions about the Profile. This person will automatically be added as a user for the Healthy Schools Act School Health Profile and will receive a PDF copy of the completed HSA School Health Profile via for posting per section 602(c) of the Healthy Schools Act. 810 First Street, NE, 4th Floor Washington, DC Page 2
3 Section 2: Health Services Section 2: Health Services Recommended point of contact for this section: School Health Providers Recommended point of contact for this section: School Health Providers 10. What type of nurse coverage does your school have?* Full-time Part- time coverage 11. How many nurses are available at your school? * One Two Three or more 11a. Name of School Nurse 1 11a1. School Nurse 1 Delphenia James delphenia.james@dc.gov 11b. Name of School Nurse 2 11b1. School Nurse 2 11c. Name of School Nurse 3 11c1. School Nurse Does your school currently have a School Mental Health Program or similar services on site for students?* 13. How many of the following clinical staff does your school currently employ? Psychiatrist # full time # part time Psychologist # full time # part time 1 Licensed Independent Clinical Social Worker (LICSW) # full time # part time Licensed Professional Counselor (LPC) # full time # part time 14. Do you partner with any outside organizations or agencies to address social-emotional needs, improve school climate around mental health, and/or provide for mental health needs? 14a. Please specify the agency or organization: 15. Does your school see a need for more school-based behavioral/mental health services than you currently have? Has your school ever used the Child and Adolescent Mobile Psychiatric Services (ChAMPS) or the Department of Mental Health s Access Helpline? 17. Does your school currently have an anti-bullying policy? Don t know 17a. If yes, is it complaint with the Youth Bullying Prevention Act of 2012? Don t know 18. Does your school have a student-led club that aims to create a safe, welcoming, and accepting school environment for all youth, regardless of sexual orientation or gender identity? These clubs sometimes are called gay/straight alliances. Don t know 810 First Street, NE, 4th Floor Washington, DC Page 3
4 Section 3: Health Education Section 3: Instruction Health Education Instruction Recommended Recommended point point of contact of contactfor for this section: Health Health Education Education Teacher Teacher 19. Are students required to take health education at your school?* 20. Does your school currently have at least one certified or highly qualified health teacher on staff?* 21. How many health education teachers does your school currently have on staff?* ne One Two Three or more 22a. Name of Health Ed Instructor 1* 22a1. Health Ed Instructor 1 Beverly Clavon beverly.clavon@dc.gov 22b. Name of Health Ed Instructor 2* 22b1. Health Ed Instructor 2 22c. Name of Health Ed Instructor 3* 22c1. Health Ed Instructor How is health education instruction provided? Health education course Assemblies or presentations health education is provided Incorporated into another course Other: 24. For each grade in your school, please indicate the average number of minutes per week during the regular instructional school week that a student receives health education instruction:* Grade: PS Minutes/Week: Grade: 4 Minutes/Week: Grade: 10 Minutes/Week: Grade: PK Minutes/Week: Grade: 5 Minutes/Week: Grade: 11 Minutes/Week: Grade: K Minutes/Week: Grade: 6 Minutes/Week: Grade: 12 Minutes/Week: Grade: 1 Minutes/Week: Grade: 7 Minutes/Week: Adult : Minutes/Week: Grade: 2 Minutes/Week: Grade: 8 Minutes/Week: Other : Minutes/Week: Grade: 3 Minutes/Week: Grade: 9 Minutes/Week: Is the health education instruction based on OSSE s health education standards?* 26. For the health topics listed, please specify which health education curriculum (or curricula) your school uses for instruction: Grade: PS 810 First Street, NE, 4th Floor Washington, DC Page
5 Grade: PK Grade: K Grade: 1 Grade: First Street, NE, 4th Floor Washington, DC Page 5
6 Grade: 3 Grade: 4 Grade: 5 Grade: First Street, NE, 4th Floor Washington, DC Page 6
7 Grade: 7 Grade: 8 Grade: 9 Grade: 10 DCPS Health standards supplemented with Discovery Health modules and California State curriculum materials DCPS Health standards supplemented with Discovery Health modules and California State curriculum materials DCPS Health standards supplemented with Discovery Health modules and California State curriculum materials DCPS Health standards supplemented with Discovery Health modules and California State curriculum materials DCPS Health standards supplemented with Discovery Health modules and California State curriculum materials DCPS Health standards supplemented with Discovery Health modules and California State curriculum materials DCPS Health standards supplemented with Discovery Health modules and California State curriculum materials DCPS Health standards supplemented with Discovery Health modules and California State curriculum materials DCPS Health standards supplemented with Discovery Health modules and California State curriculum materials 810 First Street, NE, 4th Floor Washington, DC Page 7
8 Grade: 11 Grade: 12 Grade: Adult Grade: Other 810 First Street, NE, 4th Floor Washington, DC Page 8
9 27. Does your school partner with any outside programs or organizations to satisfy the health education requirements?* 27a. Please specify the agency or organization agency: 810 First Street, NE, 4th Floor Washington, DC Page 9
10 Section 4: Physical Education Instruction Recommended point of contact for this section: Physical Education Teacher 28. Are students required to take physical education at your school?* 29. Does your school currently have at least one certified or highly qualified physical education teacher on staff? 30. How many physical education teachers does your school have on staff?* ne One Two Three or more 31a. Name of Physical Education Instructor 1 31ai. Physical Education Instructor 1 Nikki Sutton nikki.sutton@dc.gov 31b. Name of Physical Education Instructor 2 31bi. Physical Education Instructor 2 31c. Name of Physical Education Instructor 3 31ci. Physical Education Instructor What strategies does your school use, during or outside of regular school hours, to promote physical Activity? select all that apply Active Recess Movement in the Classroom Walk or Bike to School After-School Activities Athletic Programs Safe Routes to School ne Other: dance; marching band 33. For each grade in your school, please indicate the average number of minutes per week during the Regular instructional school week that a student receives physical education instruction.* Grade: PS Minutes/Week: Grade: 4 Minutes/Week: Grade: 9 Minutes/Week: Grade: PK Minutes/Week: Grade: 5 Minutes/Week: Grade: 10 Minutes/Week: Grade: K Minutes/Week: Grade: 6 Minutes/Week: Grade: 11 Minutes/Week: Grade: 1 Minutes/Week: Grade: 7 Minutes/Week: Grade: 12 Minutes/Week: Grade: 2 Minutes/Week: Grade: 8 Minutes/Week: Grade: Other Minutes/Week: Grade: 3 Minutes/Week: 34. For each grade that receives physical education instruction, please indicate the average number of minutes per week during the regular instructional school week devoted to actual physical activity within the physical education course.* Grade: PS Minutes/Week: Grade: 4 Minutes/Week: Grade: 9 Minutes/Week: Grade: PK Minutes/Week: Grade: 5 Minutes/Week: Grade: 10 Minutes/Week: Grade: K Minutes/Week: Grade: 6 Minutes/Week: Grade: 11 Minutes/Week: Grade: 1 Minutes/Week: Grade: 7 Minutes/Week: Grade: 12 Minutes/Week: 225 Grade: 2 Minutes/Week: Grade: 8 Minutes/Week: Grade: Other Minutes/Week: Grade: 3 Minutes/Week: First Street, NE, 4th Floor Washington, DC Page 10 10
11 35. Is the physical education instruction based on OSSE s physical education standards?* 36. Which physical education curriculum (or curricula) is your school currently using for instruction? Grade: PS Grade: 6 Grade: PK Grade: 7 Grade: K Grade: 8 Grade: 1 Grade: 9 Grade: 2 Grade: 10 Grade: 3 Grade: 11 Grade: 4 Grade: 12 Grade: 5 Grade: Other SPARK; HopSports, Physical Best Activity Guide SPARK; HopSports, Physical Best Activity Guide SPARK; HopSports, Physical Best Activity Guide SPARK; HopSports, Physical Best Activity Guide 37. Which physical activity curriculum (or curricula) is your school currently using for instruction? Grade: PS Grade: 6 Grade: PK Grade: 7 Grade: K Grade: 8 Grade: 1 Grade: 9 Grade: 2 Grade: 10 Grade: 3 Grade: 11 Grade: 4 Grade: 12 Grade: 5 Grade: Other SPARK; HopSports, Physical Best Activity Guide SPARK; HopSports, Physical Best Activity Guide SPARK; HopSports, Physical Best Activity Guide SPARK; HopSports, Physical Best Activity Guide 38. Does your school use a physical education or fitness assessment tool?* (e.g., Fitness-gram, President s Physical Fitness Test, etc.) 38a. What is the name of the tool? Fitnessgram; President's Physical Fitness Test 39. Does your school partner with any outside programs or organizations to satisfy the physical Education or physical activity requirements?* 39a. Please specify the agency or organization: 810 First Street, NE, 4th Floor Washington, DC Page 11
12 40. How many days per week do students get recess?* Grade: PS # of Days: Grade: 6 # of Days: Grade: PK # of Days: Grade: 7 # of Days: Grade: K # of Days: Grade: 8 # of Days: Grade: 1 # of Days: Grade: 9 # of Days: Grade: 2 # of Days: Grade: 10 # of Days: Grade: 3 # of Days: Grade: 11 # of Days: Grade: 4 # of Days: Grade: 12 # of Days: Grade: 5 # of Days: Grade Other: # of Days: Grade ' Other: # of Days: How many minutes is one (1) recess period?* Grade: PS # of Minutes: Grade: 6 # of Minutes: Grade: PK # of Minutes: Grade: 7 # of Minutes: Grade: K # of Minutes: Grade: 8 # of Minutes: Grade: 1 # of Minutes: Grade: 9 # of Minutes: Grade: 2 # of Minutes: Grade: 10 # of Minutes: Grade: 3 # of Minutes: Grade: 11 # of Minutes: Grade: 4 # of Minutes: Grade: 12 # of Minutes: Grade: 5 # of Minutes: Grade Other: # of Minutes: Grade Other: # of Minutes: ' What is the estimated operating budget for your physical activity programs? $1, First Street, NE, 4th Floor Washington, DC Page 12 11
13 Section 5: Programs Recommended point of contact for this section: Food Services Director or Manager 43. Name of Food Service Vendor* Chartwells 44. What types of nutrition promotion does your vendor provide?* ne Multimedia Vendor-provided nutrition education Posters Meal time presentations Classroom Instruction Outside speakers Handouts/brochures Other (please specify if a specific nutrition curricula is used): 44a. Please comment on the quality and/or effectiveness of the nutrition promotion that your vendor provides: It's helpful but additional promotion is needed 45. Does your school offer free breakfast to all students?* 46. Does your school offer breakfast in the classroom? 46a. If yes, please specify the grades for which breakfast is served in the classroom: PS Adult PK Other K b. If you do not offer breakfast in the classroom, please explain why (i.e., not required): 47. Does your school offer any alternative breakfast models? Cafeteria Grab and Go cart Second chance/extend Other, please specify 47a. Where is your Grab and Go cart located? In the cafeteria In/near the main entrance of the school Other If other, please specify 810 First Street, NE, 4th Floor Washington, DC Page 13
14 Section 5 (Continued ) : Programs Recommended point of contact for this section: Food Services Director, Cafeteria Manager 48. Does your school provide meals that meet the nutritional standards required by the federal and District laws, such as the Healthy Hunger-Free Kids Act and the Healthy Schools Act? These requirements (for lunch) include: a different vegetable every day; dark green, red/orange, dry beans/peas, starchy, and other vegetables each week; a different fruit every day; fresh fruit at least 3 times per week; 100% juice only once per week; a whole grain-rich serving every day; 3 different types of whole-grain rich foods each week; only low-fat (1% or less) or fat-free (skim) fluid milk each day. 49. On average, how many minutes is one (1) lunch period?* 50. Does your school serve locally grown and/or locally processed and unprocessed foods at meal Times? 50a. Are these items served at breakfast? 50 50b. Are these items served at lunch? 51. Is cold, filtered water available to students during meal times?* 51. Is cold, filtered water available to students during meal times?* 810 First Street, NE, 4th Floor Washington, DC Page 13 14
15 Section 6: Local Wellness Section Policy 6: Local Wellness Policy Recommended point of contact for this section: Principal, Chair of School Wellness Recommended point of contact for this section: Principal, Chair of School Wellness Council/Committee Council/Committee 52. All Local Education Agencies (LEAs) in DC have a local wellness policy. Has your LEA s local wellness policy been distributed to the following? Parent/teacher organization Wellness committee/council Foodservice staff Administrators Students ne Other 53. Is your school implementing your LEA s local wellness policy? 53a. Name of Head of Wellness Committee* 53b. Head of Wellness Committee * Donna Hollis donna.hollis-walker@dc.gov 54. Does your school have vending machines available to students?* 55a. How many student vending machines do you have: 55b. What are the hours of operation of student vending machines? 55c. What items are sold from student vending machines? 55d. Do the items comply with the Healthy Schools Act? 56. Does your school sell foods or beverages of any kind for fundraisers? 57. Does your school have a school store?* 57a. What are the hours of operation for the school store? 57b. What food and beverages are sold? 810 First Street, NE, 4th Floor Washington, DC Page 15 14
16 Section 7: Distributing Section Information 7: Distributing Information 58. Where are the following items located at your school? LEA s Local Wellness Policy* School Website School Main Office School Cafeteria or Eating Areas This information is not available Other: School Menu for Breakfast and Lunch* School Website School Main Office School Cafeteria or Eating Areas This information is not available Other: al Content of Each Menu Item* School Website School Main Office School Cafeteria or Eating Areas This information is not available Other: Ingredients of Each Menu Item* School Website School Main Office School Cafeteria or Eating Areas This information is not available Other: Information on where fruits and vegetables served in schools are grown and processed and whether growers are engaged in sustainable agriculture practices* School Website School Main Office School Cafeteria or Eating Areas This information is not available. Other: 59. Are students and parents informed about the availability of vegetarian food options at your school?* Vegetarian food options are not available 59a. Where can they find this information? School Website School Main Office School Cafeteria or Eating Areas Other: 60. Are students and parents informed about the availability of milk alternatives, such as soy milk, lactose free milk, etc., at your school?* Milk alternatives are not available 60a. Where can they find these options? School Website School Main Office School Cafeteria or Eating Areas Other 810 First Street, NE, 4th Floor Washington, DC Page 15 16
17 Section 8: School Gardens Section 8: School Gardens Recommended point of contact for this section: School Garden Coordinator Recommended point of contact for this section: School Garden Coordinator 61. Does your school currently have a School Garden?* 61a. Name of Garden Contact 61b. Garden Contact 62. How many unique students participated in your school garden program this year? 63. In what year was this garden established? 64. Which grades are most impacted by the school garden program? Pre-School Grades K-5 Grades 6-8 Grades Please list any partners that have supported your garden program this school year: 66. What is the approximate size of your garden in square feet? 67. What type of school garden do you have? s Edible Garden Pollinator/Butterfly Garden Greenhouse Stormwater/Rain Garden Wildlife Habitat/Native Garden Other: 68. When do activities happen in the school garden? Classroom instruction (during the school day) Extracurricular activities (outside the school day) Lunch time activities Summer time 69. What topic is most frequently taught in the school garden? Environment STEM English Math Art Other: 70. What is the estimated operating budget for your school garden? 71. Did your school participate in Growing Healthy Schools Week (September 27- October 3, 2014) or planning to participate in Strawberries and Salad Greens Day (May 2015)? 810 First Street, NE, 4th Floor Washington, DC Page 16 17
18 72. Does your school have a school-wide recycling program? 72a. Which of these materials does your school recycle (materials recycled/composted off site)? Aluminum Food waste Paper Cardboard Glass Plastics ne of the above 73. Does your school compost on-site?, outside on school grounds, inside in classroom worm bins, other method 810 First Street, NE, 4th Floor Washington, DC Page 18
19 Section 9: Environmental Literacy Recommended point of contact for this section: Lead Science Teacher 74. Does your school offer an Environmental Science Class?* 74a. How many students were enrolled in this course in the school year? Name of Lead Science Teacher / Environmental Literacy Instructor Jaime Ratkoff 75a. Lead Science Teacher/ Environmental Literacy Instructor jaime.ratkoff@dc.gov 76. Please select the environmental literacy topics currently addressed in your school. For each selection, indicate the course in which the topic is taught and the curriculum (or curricula) that your school is currently using for instruction: GRADE: PK ne: 810 First Street, NE, 4th Floor Washington, DC Page 19
20 GRADE: K Water (stormwater, rivers, aquatic wildlife ) ne: GRADE: 1 ne: GRADE: 2 ne: 810 First Street, NE, 4th Floor Washington, DC Page 18 20
21 GRADE: 3 : ne: GRADE: 4 ne: GRADE: 5 ne: 810 First Street, NE, 4th Floor Washington, DC Page 19 21
22 GRADE: 6 ne: GRADE: 7 ne: GRADE: 8 ne: 810 First Street, NE, 4th Floor Washington, DC Page 20 22
23 GRADE: 9 ne: GRADE: 10 ne: GRADE: 11 Environmental Science Environmental Science Environmental Science Environmental Science Environmental Science ne: DCPS Science Standards; NGSS; Holt Environmental Science 7th Edition DCPS Science Standards; NGSS; Holt Environmental Science 7th Edition DCPS Science Standards; NGSS; Holt Environmental Science 7th Edition DCPS Science Standards; NGSS; Holt Environmental Science 7th Edition DCPS Science Standards; NGSS; Holt Environmental Science 7th Edition 810 First Street, NE, 4th Floor Washington, DC Page 21 23
24 GRADE: 12 Environmental Science Environmental Science Environmental Science Environmental Science Environmental Science ne: GRADE: Adult ne: GRADE: Other ne: DCPS Science Standards; NGSS; Holt Environmental Science 7th Edition DCPS Science Standards; NGSS; Holt Environmental Science 7th Edition DCPS Science Standards; NGSS; Holt Environmental Science 7th Edition DCPS Science Standards; NGSS; Holt Environmental Science 7th Edition DCPS Science Standards; NGSS; Holt Environmental Science 7th Edition 810 First Street, NE, 4th Floor Washington, DC Page 22 24
25 Section 10: Posting Section and 10: Form Posting Availability and Form to Availability Parents to Parents According to section 602(c) of the Healthy School Act of 2010, each public school and public charter school shall post the information required by subsection (a) online if the school has a website and make the form available to parents in its office. 77. How will you make this information available to parents?* Online Other (please specify): Copies Available at Main Office 78. Is your school sharing information about the Healthy Schools Act in any other ways? 78a. Please explain: Date Modified: Last Modified by: 810 First Street, NE, 4th Floor Washington, DC Page 25 23
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