PI-8601 Page 3

/ Wisconsin Department of Public Instruction
EARLY CHILDHOOD/4K NUTRITION EDUCATION
MINI-GRANT APPLICATION
PI-8601 (New 03-10 ) / INSTRUCTIONS: Applications must be received and postmarked no later than May 31, 2010. Late, faxed, or emailed copies will not be accepted. Return to:
WISCONSIN DEPARTMENT OF PUBLIC INSTRUCTION
ATTN: JILL CAMBER DAVIDSON
COMMUNITY LEARNING AND PARTNERSHIPS
P.O. BOX 7841
MADISON, WI 53707-7841
Collection of this information is a requirement of Public Law 108-265.
I. GENERAL INFORMATION
1. Name of School District / 2. Program Name
3. Address Street, City, State, Zip / 4. Telephone Area/No.
5. Administrative Contact Person / 6. Administrative Contact Person’s E-mail Address
7. Administrative Contact Person’s Address Street, City, State, Zip / 8. Telephone Area/No.
9. School Building Name / 10. Program Enrollment / 11. Meals/Snacks Served
Breakfast / AM Snack / Lunch / PM Snack / Others Specify
II. ASSURANCES
This grant award is for the following Early Childhood or 4 Year Old Kindergarten Program/School:
1.  The recipient agrees the project will be implemented according to the approved plan submitted in the grant application.
2.  The grant shall be implemented in accordance with all applicable statutes, applicable regulations, and grant guidelines.
3.  Funds may be used to support but not supplant services already funded through local, state, or federal funds.
4.  The recipient shall perform the work and services described in the grant proposal, including any amendments submitted to meet specific conditions.
5.  The recipient shall conduct the project in accordance with grant assurances.
6.  A final program fiscal report (PI-1086) must be received by the Department of Public Instruction (DPI) no later than
7.  September 30, 2011.
8.  The recipient shall submit an interim program report to DPI by December 30, 2010, and an end-of-year program report to DPI by June 30, 2011.
The Site/School/District agrees to:
1. Complete the project during the time frame July 1, 2010 through June 30, 2011.
2. Designate a site contact that will oversee the project locally and will complete, administer, collect, and return the pre/post assessments, reports and lesson evaluations to DPI.
3. Designate at least one person from the site to attend a Role Modeling the ABCs of Nutrition Education training and serve as a site resource person.
4. Inform and involve Parents in this and other nutrition education and physical activity programs
5. Serve as a model for other schools/districts. Share knowledge, experience, and recommendations from this project for applicable publications and presentations. Share progress with the DPI, as appropriate.
6. Register all schools in the district as TEAM nutrition schools (register with USDA) if applicable.
Funding Guidelines:
1.  Food: The food must be part of a specific educational activity and be related to Nutrition Education activities specified under objectives of the mini grant proposal or work plan. Funds should NOT be used to purchase a meal, including snacks, for anyone.
2.  Food and Nutrition Equipment: Funds may not be used to purchase Food Service equipment. Small mobile kitchen equipment used for classroom demos or hands-on food experiences may be permissible if part of a specified integrated Nutrition Education lesson. Total expenditures for food and nutrition-related equipment should not exceed 10% of total mini grant awarded.
3.  Medical Equipment: TN funds may not be used to purchase medical equipment or health services related to health assessments such as obtaining clinical data on nutritional status, chronic disease or chronic disease risk assessment. Therefore, measurement of height, weight, skin fold thickness, blood pressure, cholesterol and blood glucose and iron levels are not allowable.
4.  Physical Activity: Educational program materials developed with Team Nutrition funds to promote PA for all target audiences must include messages that link Nutrition and PA such as “balance your day with food and play.” Team Nutrition funds are not intended to purchase pedometers or award pins for everyone, or to subsidize the regular PE program in the schools. Cost associated with physical activity should not significantly detract from funds for promoting healthy eating. Team Nutrition funds may NOT be used to purchase playground equipment, exercise or sports’ equipment, sports lessons, or to pay for services of a for-profit physical fitness organization.
5.  Promotional/Incentive Items: Team Nutrition grants are to promote Team Nutrition messages, not Team Nutrition itself. Any promotional items or incentive should promote one or more of the Team Nutrition messages or refer the target audience to a website that provides Team Nutrition messages.
6.  Staff Development and/or substitute pay: Nutrition education sessions are a required component of this grant. Staff development wages and travel and substitute pay are allowable expenses. A record of who attended the session, how long it lasted and the purpose of the session is required.
7.  Gardening: Team Nutrition funds may purchase a reasonable amount of supplies (seeds, potting soil, and starter pots) for classroom gardening projects or even a few shovels and hoes for a school gardening project. Funds may NOT be used to purchase bulk soils such as topsoil, irrigation supplies, fencing, or any type of large equipment such as a tiller or greenhouse. Schools are encouraged to partner with local garden supply sources for creating sustainable gardening project after Team Nutrition grant period.
III. NARRATIVE
1. Describe current parent involvement programs and initiatives at your site (newsletters, parent bulletin board, parent meetings, etc.).
2. What nutrition and/or food related activities do you provide for your students (type of activity, how often)?
3. What types of physical activities do you provide for your students (type of activity, how often, how long)?
4. Are you willing to conduct a pre-post survey of your site, and provide feedback on the nutrition curriculum?
Yes
No
IV. SIGNATURES
WE, THE UNDERSIGNED, CERTIFY that this application will be the basis for the operation and administration of the project for which funds will be requested. We will provide expenditure and other reports and will comply with such fiscal provisions as the Department of Public Instruction requires. We also agree to comply with the assurances and requirements outlined herein.
Signature of District Administrator
Ø / Date Signed
Signature of Fiscal Agent
Ø / Date Signed
V. BUDGET SUMMARY
Function /
Object / Funds Requested /
For DPI Use
INSTRUCTION
Activities dealing directly with the
interaction between instructional staff and students. (This category includes teaching aids and supplies.) / Salaries (100s)
Fringes (200s)
Purchased Services (300s)
Non-Capital Objects
and Supplies (400s)
Capital Objects (500s)
TOTAL Instruction / $0
ADMINISTRATIVE
Administrative costs are limited to not more than 5percent of the amount requested. / Salaries (100s)
Fringes (200s)
Purchased Services (300s)
Non-Capital Objects (400s)
Capital Objects (500s)
TOTAL Administrative / $0
SUPPORT SERVICES
Support services are those which facilitate and enhance instructional or other components of this project.
(This category includes staff development.) / Salaries (100s)
Fringes (200s)
Purchased Services (300s)
Non-Capital Objects (400s)
Capital Objects (500s)
TOTAL Support Services / $0
TOTAL / $0