Last year, the six school nurses in Indiana who received grants were:

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1 Dear School Nurse, Heart health continues to be a top concern for all of us. Like you, we re concerned about our young people and are pleased to once again offer an opportunity to work with you to educated school children about the importance of maintaining a healthy heart. For the second year in a row, we are working with members of the Indiana Association of School Nurses to sponsor the school nurse grant project to promote cardiac health among school-aged children. Working with your Indiana Association of School Nurses, Anthem Blue Cross and Blue Shield will fund $5,000 in grants to school nurses in your state for the school year. Last year, the six school nurses in Indiana who received grants were: Susan Stiffney, Goshen High School Jeanne Winans, Paul Harding High School Susan Huber & Mary Jo Carter, Perry Central Elementary School Melody Oeth, West Elementary School Kelly Brown, Westfield Intermediate School Sandra Kohut & Carol Blanchard, Whitley County Consolidated Schools The Anthem School Nurse Grant Project is designed to help address unhealthy lifestyle choices such as poor eating habits and nutrition and a lack of proper exercise. I encourage you to apply for a grant of up to $1,000 to start a program at your school that encourages healthy lifestyles, educates about reducing cardiovascular risk factors and promotes physical activity and the establishment of sound eating habits. Information on the project and how to apply is enclosed. Anthem s mission is to improve the health of the people we serve, and we are pleased to work with you and support programs that help young people in our communities learn how to live healthier lives. Please take the time to read the materials in this packet and consider applying for a grant. Together, we can build a healthier future for today s children. Our efforts can serve as a foundation for a lifetime of better health. Sam Nussbaum, M.D. Executive Vice President and Chief Medical Officer Anthem, Blue Cross Blue Shield

2 Anthem Blue Cross and Blue Shield Cardiac Care Program 2005 School Nurse Grant Project Grant Information Anthem s mission is to improve the health of the people we serve. Anthem recognizes that a real health problem in our nation is childhood obesity. Approximately ten million American children and adolescents are obese. In the past 20 years, the number of overweight children in America has doubled and the number of overweight teens has tripled. These children and adolescents are at a significantly increased risk for a host of weight-related illnesses as adults, including diabetes and heart disease. Health care professionals agree that improving children s nutrition and increasing physical activity are two effective ways to combat the epidemic of childhood obesity. The mission of Anthem s School Nurse Grant Project is to promote cardiovascular health among school-age children. Anthem s goals are to: assist school nurses in initiating programs that may encourage a healthy lifestyle, reduce cardiovascular risk factors, promote physical activity, and encourage healthy eating behaviors facilitate the development of innovative school health programs that are based on research A state-specific committee consisting of members of State School Nurse Association and Anthem representation will review the grant proposals. The committee will review and score the proposals based on the following criteria: Well-defined goals and objectives that are consistent with the grant project goals (as listed above) Appropriate activity for scope of nurse s work responsibilities Appropriate activity for target population Appropriate budget request Appropriate process for evaluating outcomes Qualified Applicants Eligible applicants include school nurses who are licensed in the state in which they practice and who represent a public or private school (elementary, junior high, middle, or high school) in Ohio, Kentucky or Indiana. Documentation of the school s non-profit status is required. No awards will be made to individuals, but will be awarded to the school. Funds Available Unrestricted nonrenewable grants will be funded in amounts ranging from $500 to $1,000 per school with a maximum of $5,000 allocated per state (Ohio, Kentucky and Indiana). Funding requests must be consistent with the scope of work and budget. Funds cannot be used for the salary or wages of any staff or employee.

3 Project Timeframe Grant proposals must be submitted by February 1, The projects must be initiated in the fall of 2005 and completed before June 1, Notification Applicants will be notified of grants awarded by March 15, 2005 with funds distributed at that time. A representative from Anthem s Cardiac Care Program or a delegated representative from Anthem will be available to recognize the grant awardees at the local state conference in The school superintendent, principal of the school and/or school nurse selected for the grant or their delegated representative will be recognized as a grant recipient, on behalf of the school. Application Process To apply for a grant, the school nurse representing the school must submit a completed application form with the appropriate attachments no later than February 1, Any application form received after February 1, 2005 will not be considered for the school year but can be re-submitted the following year for consideration for the school year. Mail original proposal and three copies to: INDIANA School Nurses Phyllis J. Lewis, Coordinator of School Health Indiana Department of Education Office of Student Services Rm. 229 State House Indianapolis, IN For questions, please contact: Carol Homann (Past President of the Indiana Association of School Nurses) at or [email protected] Brenda Henry (President of the Indiana Association of School Nurses) at or [email protected] OHIO School Nurses Gabrielle Karpowicz, RN, BSN, MA 6167 Heritage Point Ct. Hilliard, OH [email protected]

4 KENTUCKY School Nurses Mary Burch, RN School Nurse/Local District Health Coordinator Erlanger-Elsmere Board of Education 500 Graves Avenue Erlanger, KY Reporting Requirements All 2005 grant recipients must submit the following items to the same individual listed above for their respective state no later than August 1, 2006: Completed Program Evaluation form and written program evaluations completed by students and/or school personnel. One copy of all brochures, announcements, materials, etc. that were used to promote and implement the program. For more information, contact the School Nurse Association representative listed above for your respective state or Jeanne Lehn, RN, Cardiac Program Administrator, Anthem Blue Cross & Blue Shield, at or

5 Application Form Due by February 1, 2005 Anthem Blue Cross and Blue Shield Cardiac Care Program 2005 School Nurse Grant Project Please complete all items on the application form and attach the following documents: Description of school and student population (250 words or less) Background information (i.e. needs assessment) to explain why this program is needed and how it would be beneficial to the school (250 words or less) Discussion of research that supports need for the program (1 page maximum with appropriate bibliography) Proposed itemized budget with rationale for total requested amount (not to exceed $1,000.00). Mail original application form, attachments and three copies to the appropriate state school nurse association: INDIANA School Nurses Phyllis J. Lewis, Coordinator of School Health Indiana Department of Education Office of Student Services Rm. 229 State House Indianapolis, IN OHIO School Nurses Gabrielle Karpowicz, RN, BSN, MA 6167 Heritage Point Ct. Hilliard, OH KENTUCKY School Nurses Mary Burch, RN School Nurse/Local District Health Coordinator Erlanger-Elsmere Board of Education 500 Graves Avenue Erlanger, KY

6 Anthem Blue Cross and Blue Shield Cardiac Care Program 2005 School Nurse Grant Project Application Form (Must be TYPED) Date: School Name: School Address: School Phone Number: School Nurse: School Nurse Address: Principal: School Superintendent: Goals/Objectives of the program: 1) 2) 3) Target population for program including demographics of students (i.e. ethnicity, age, gender, rural/urban) and how many students will be served Resources required to accomplish the specified outcomes within the given school year:

7 Explanation of how the program s success (outcomes) will be evaluated/measured: Tax ID number: Expiration date: Signatures: Principal School Nurse