2013-14 Health Education Leadership Program Application PDF View for Application Preparation

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2013-14 Health Education Leadership Program Application PDF View for Application Preparation The Health Education Leadership Program and Leadership Circle: The Health Education Leadership Program and the Leadership Circle are two new initiatives in the Office of School Wellness Programs (OSWP), in partnership with the Mayor s Office and the Center for Economic Opportunity, to support comprehensive health education in schools that serve middle and high school grades. The Health Education Leadership Program provides middle and high school administrators and teachers from 55 schools with training, technical assistance, individualized support, curricula, and materials to provide students with quality health education, including sexual health education. The Leadership Circle, composed of 20 high schools, will receive an additional level of support including funding ($1,500) for centrally purchased goods, services, and per session. Both groups work directly with experienced health educators from OSWP to become models of instructional and programmatic excellence, especially related to aligning health instruction with the Common Core Learning Standards and the Danielson framework. All participating schools will receive a package of materials valued at more than $500 (curricula, books, classroom resources, student materials) as well as free training and individualized support. To see an overview of the program and requirements of the grant before completing the survey, click here. For a PDF of the application and scoring rubric to use as you prepare for your Leadership Circle grant application, click here. Application deadline is October 16, 2013. Schools will be notified of program status no later than early November. (End of Page 1) Part I: School Information 1. School Information (if multiple sites, include all grade levels served and estimate total enrollment) School Name: District Borough Number (DBN, e.g., 12X202) Grade Levels Served: Principal Name (Last, First) Principal email (DOE only) (End of Page 2)

Part II: Applicant/ Designee Information 2. Lead Applicant Last Name, First Name (e.g., Doe, John): DOE Email: 3. Lead Applicant Primary School Role Health Teacher Principal PE Teacher Teacher Assistant Principal Nurse Secretary Counselor School Based Health Center Staff 4. Other Designee to Include on Communications Last Name, First Name (e.g., Doe, John): DOE Email: 5. Other Designee Primary School Role Health Teacher

Principal PE Teacher Teacher Assistant Principal Nurse Secretary Counselor School Based Health Center Staff (End of Page 3) Part III: School Health Information These answers are informational only. Answers will not be used to influence eligibility or collected as compliance data. 6. Our school has a (Check all that apply) School-based Health Clinic Working relationship with an outside clinic School Wellness Council Condom Availability Program (high schools only) 7. Health class curricula currently includes, to any extent: (Check all that apply)

Recommended (HealthSmart, Reducing the Risk, NYC DOE HIV Curriculum) Teacher created lessons Outside organizations that assist 8. What type of support would you like your school to receive as part of this program? (Check all that apply) Scheduling School environment Aligning instruction with CCLS goals Teacher support (e.g., health education knowledge, comfort with subject matter, classroom management) 9. For which level of support is your school applying Health Education Leadership Program (55 middle and high schools) Leadership Circle (20 high schools) If you select Health Education Leadership Program, you will automatically go to the assurances at the end of the survey. If you select Leadership Circle, you will continue with competitive survey questions. (End of Page 4)

Part IV. Health Education Leadership Circle Please answer the following three questions as thoroughly as possible. The responses to these questions will be evaluated based on this rubric. 10. What are the health education-related challenges specific to your student population? In your answer, be as detailed as possible to include information about your current health education program (classes offered, grades taught, etc.). 11. What changes would you like to bring about in your school health education program to better address these challenges or build on current strengths? 12. Provide an overall vision of what you would like to do in your school with the Leadership Circle support that would provide sustainable health education improvements. (End of Page 5) Part IV: Agreements and Accountability 13. Read each statement and check the box to indicate acceptance of each Leadership Circle program requirement. The health teacher is scheduled to teach two or more high school health education classes per semester in 2013-14 (exceptions available for new or small schools). The principal and teacher commit to using Reducing the Risk and HealthSmart curriculum in the Spring 2014 semester (OSWP will provide training, curricula and student materials). The health teacher agrees to participate in/principal agrees to release teacher for the five Leadership Circle workshops (including full day events in mid November and June 5, 2014, and three after school workshops supported by teacher training rate) and two additional OSWP professional developments throughout the school year (e.g., HIV curriculum, Condom Availability Program). The health teacher and principal will complete and submit a health education assessment, an action plan, and a budget for centrally purchased goods, services and/or per session.

The survey will end here for Leadership Circle applicants. 14. Read each statement and check the box to indicate acceptance of each Health Education Leadership Program requirement. Principal supports this application and partnership and designates a key pointperson for this project, preferably a health teacher. Health teacher (and/or designee) will share experiences teaching health education with support staff, and commit to incorporate suggested recommendations as needed. Health teacher (and/or designee) agrees to participate in at least one OSWPsponsored health education event. Principal will meet at least once with OSWP Health Education Mentor to discuss school-wide considerations affecting health education (i.e., scheduling of classes). The survey will end here for Health Education Leadership Program applicants When you select "submit" below, you will see your application results and have the option to print it for your records and/or email it to administrators, council members, or members of your school community. Thank you for your commitment to student wellness. We will notify you of your grant status by early November at the latest. (End of Page 6)