Page 1PI-6028
II. NARRATIVE (cont’d)/ Wisconsin Department of Public Instruction
SERVING UP MYPLATE SUBGRANT APPLICATION
PI-6028 (New 04-17) / INSTRUCTIONS: To apply for a Serving Up MyPlate Subgrant complete this application by June 9, 2017, and return to:
WISCONSIN DEPARTMENT OF PUBLIC INSTRUCTION
ATTN: ALICIA DILL OR KELLY WILLIAMS
SCHOOL NUTRITION TEAM
PO BOX 7841
MADISON, WI 53707-7841
All fields are required.
I. GENERAL INFORMATION
1. Public School District/Private School / 2. Agency Code / 3. CESA No.
123456789101112 / 4. DUNS Number
5. Mailing Address Street, City, State, Zip / Grant Period
Begin Year
8/21/2017 / End Year
1/26/2018
6. School Building Name / 7. Team Nutrition School*
YesNo
8. School Building Mailing Address Street, City, State Zip
9. Grant/Project Coordinator / 10. Title
11. Email Address / 12.Telephone Area/No.
List the third and/or fourth grade teachers that will be participating inthe grant activities.
Teacher Name / Teacher Email / Anticipated Class Enrollment
* All schools must be enrolled as Team Nutrition Schools to qualify for funding eligibility. Visit to confirm your school’s enrollment. To enroll for free, visit
Page 1PI-6028
II. NARRATIVE (cont’d)II. NARRATIVE
1.Are you willing to utilize USDA Team Nutrition curriculum Serving Up MyPlate: A Yummy Curriculum?
YesNo / 2.Are you willing to complete an evaluation regarding your nutrition education activities at the end of the grant period?
YesNo
3.Are you willing to conduct a pre- and post-program student evaluation regarding the student’s nutrition knowledge and willingness to try foods?
YesNo / 4.Is the School Nutrition Director willing to share two weeks of production records to assess vegetable selection among students?
YesNo
5.Explain why you want to incorporate nutrition education into your classroom. Describe your plan to utilizeServing Up MyPlate: A Yummy Curriculum.
6.Describe plans to partner with staff, families, and community members/organizations to support subgrant activities. Include any plans to collaborate with the School Nutrition Department (e.g., purchase or prepare recipes, host school-wide taste test events).
Page 1PI-6028
II. NARRATIVE (cont’d)III. BUDGET
Your maximum subgrant award will be calculated by multiplying the number of third or fourth grade students participating in the grant related activities by $3.
Subgrant funds can be used to:
- Purchase nutrition education materials (e.g., books or art supplies to accompany lessons) as well as print lesson handouts.
- Purchase food, supplies (e.g., plates, napkins, forks), and small kitchen equipment for classroom tasting and demonstration.
Food Cost—Subgrant funds may be used to pay for food if the food is part of a specific educational activity. For example, conducting a classroom taste test of specific fruits or vegetables, or demonstrating the making of simple, healthy snacks, is a reasonable request. The use of the food must be related to nutrition education activities specified under objectives of the subgrant proposal or work plan. Subgrant funds should not be used to purchase a meal for anyone.
Food and Nutrition Equipment—Subgrant funds may not be used to purchase foodservice operation equipment, such as salad bar equipment, refrigerators, food processors, etc. However, small mobile kitchen equipment to be used for classroom food preparation demonstration or hands on food experiences may be permissible if such activities are part of the integrated nutrition education lessons specified under the objectives of the proposed subgrants. Teachers’ commitment to teach nutrition in the classroom and share the use of the purchased mobile kitchen equipment among other teachers within the same school building, if applicable, should be clearly indicated in the subgrant proposal. A total expenditure of food and nutrition-related equipment purchases should not exceed 10percent of the total subgrant awarded.
Promotional/Incentive Items—The purpose of the Team Nutrition Grants is to promote nutrition messages that are consistent with the current Dietary Guidelines for Americans. Any promotional item or incentive should promote one or more of the Selected Messages for Consumers the Dietary Guidelines for Americans and/or the FNS Core Nutrition Messages
Any cost associated with such promotions or incentives must be reasonable in comparison to the subgrant funding. A total expenditure of promotional/incentive items should not exceed 5percent of the total subgrant awarded.
IIIa. LINE ITEM BUDGET EXPLANATION
The DPI must determine that the applicant costs under this subgrant are allowable, reasonable, and necessary. Therefore, if funding is requested for items not listed, include the item and the amount requested. It is necessary for DPI to determine the purpose of the expenditure and assurance that the expenditure is specific to the grant related activities.
Total Anticipated Classroom Enrollment
0 / Maximum Subgrant Award
$0
Item / Amount Requested
Non-Capital Objects
a.Food supplies
b.Paper supplies (plates, napkins, forks)
c.Small kitchen equipment
d.Nutrition education supplies
e.
f.
g.
h.
j.
IIIb. BUDGET SUMMARY
Public School District or Private School / Grant Period / Date Submitted Mo./Day/Yr.
Beg.
8/21//2017 / Initial Request / First Revision / Second Revision
End
1/28/2018
Budget revisions will be considered if planned expenses change. Budget revision requests must be submitted 30 days prior to the expenditure of funds by fax (608-267-0363) or email to Alicia Dill () or Kelly Williams ().
Item / Initial Budget Request / First Budget Revision / Second Budget Revision
a.Personnel / $0
b.Purchased Services / $0
c.Non-Capital Objects
TOTAL Grant Award / $0 / $0 / $0
DPI USE ONLY
Initial Budget Request
Approved
Not Approved / DPI Representative Signature
/ Date Signed Mo./Day/ Yr.
First Budget Revision
Approved
Not Approved / DPI Representative Signature
/ Date Signed Mo./Day/ Yr.
Second Budget Revision
Approved
Not Approved / DPI Representative Signature
/ Date Signed Mo./Day/ Yr.