CountyName:

POLICY,SYSTEMS,ENVIRONMENTAL(PSE)CHANGECOLLABORATIVEACTIVITIESINVOLVINGSNAP-ED(FY16)

OCTOBER1, 2015TO SEPTEMBER30,2016

Instructions:ThisformisdesignedtoreportthenumberandtypeofchangesassociatedwithPSEactivities,andtocapturequalitativeevidencetounderstandhowchangesoccurred.Pleaseusethis formtoreporttheadoptionandreachassociatedwitheachSNAP-EdPSEactivity.OneformshouldbecompletedforeachoftheFormDMulti-Level/PSEActivitiesproposedbyyourcountyinFY16.EmailcompletedformalongwithotherreportingdocumentstoXaiXiong()nolaterthanOctober19,2016.

DescriptiveTitleforthisEffortorActivity: IsthiseffortnewforyourprojectinFY16?

Yes

No(Dateprojectbegan:)

Howmanysites(partners)ororganizationsareinvolved?

Number=

Atwhatstageisthisproject?

RelationshipBuilding

Identificationofopportunities

InProgress/Ongoing-PartnershipsareinplaceandactivitiesareunderwayComplete

Listthenamesofpartneringsites/organizations(ActualorPlanned):

[Addasmanylinesasappropriate.Contributioncolumnisoptional]

PartnerOrganizationName / OrganizationTypeorSector / ContributiontotheProject
example:GoodmanCommunityCenter / AfterSchool/YouthPrograms / ProgramandMeetingSpace

Describetheintendedoutcomesoftheactivity.Howwereyousuccessfulormadeprogress?

Describeanyunintendedoutcomes(positiveorchallenges)oftheactivity.Howhavethese outcomeschangedyourstrategyoractivities?

Whatpolicy,systems,orenvironmentalchangesoccurredasaresultoftheactivity?

TypeofChangeAdoptedorImplemented
[ExamplesBelow: Pleasedeleteexamples.Includeonlychanges
andoutcomesassociatedwithyourproject] / Domainofenvironmentalsetting
[Ifapplicable, specify:Eat,learn,live,play,shop,orwork.Clicktoview settingdefinitions.] / NumberofChanges
[Example–sugarsweetenedbeveragesremovedfrommenusat3schools
=3changes.] / Estimated Reach
[Total#ofPeopleTotal#SNAP-Edeligible.]
[Example– 100
youth,50SNAP-Edeligible] / Evidence
Listtype and add attachmentsif appropriate.
[Describethedataorevidencethatdocumentsthechange.Thismaybe meetingminutes,awrittenpolicy,photographicevidence,etc.]
PolicyChanges
Improvementinhoursofoperation/timeallottedformealsorfoodservice.
Policiesforworkingparents.
Rulesforfoodsserved inmeetingsorin classrooms.
Standardsforhealthiereatingacrosstheorganization.
SchoolWellnessorchildcarewellness policy.
SystemChanges
Changeinmenus(variety,quality, offeringlighterfares).
Removingsugar-sweetenedbeveragesfromchildren’smenus.
Improvementsinfreewateraccess,taste,quality,smell,ortemperature.
Restrictionstouseoffoodasrewardsorduringcelebrations.
Changeinfoodpurchasingspecificationtowards healthierfoods.
Prioritizingfarm-to-table/increaseinfreshorlocal produce.
Enhancedtrainingonmenudesignand healthycookingtechniques.
Useofstandardized,healthyrecipes
Collectingexcess wholesomefoodtodonatetocharitable organizations.
Environmental
Improvementsin layoutordisplay offood(smarterlunchrooms.
Ediblegardens(establish, reinvigorate,ormaintainfoodgardens.
Lactationsupportsordedicatedlactationspace
Healthiervendingmachineinitiatives
Promotion(Marketing)
Pointofpurchase/ distributionprompts.
Menulabelingwithcalorie,fat,sodium,addedsugarcounts
Vendingmachinelabeling(e.g.calories,trafficlight colorcoding)
Increasedawareness ofthechangesby targetaudiences.
Other (WI Specific)
Other(WISpecific)FoodprocurementpoliciesforSafehealthyFoodPantryProject.
Improvedcapacity ofaschoolgardenthroughpartnershipwithMasterGardeners.
HealthyRetail Related
BackpackNation
Other,specify

HowwouldyoudescribetheroleofSNAP-EdCoordinator(oreducatorsifapplicable)intheProject?

(i.e.Initiatedandledproject,consultedonproject,etc)?Indicatenameofposition(coordinatororeducator)andpertinentrole.

KeyProjectPersonnel(ListSNAP-EdColleagues,OtherExtensionColleagues,andKeyIndividualsfromPartnerOrganizations.(**Maybeusedforfollow-upviapartnersurveys,interviews)

Name / Organization / Role / Time
Example:JohnSmith / HappyDaySchool / Principal,ChairofWellnessofCommittee / 3hrs/Mo(estimated)
Example:MaryBrow / UWEXFamilyLiving / ConsultedonStrategiesforreachingouttoworkingagents / 10hours(estimated)

AttachEvidenceofChange:Photos,MeetingMinutes,MediaCoverage,Etc.

[Notrequired,butrecommended]

Briefly describe how this Activity linked to, reinforced, or informed related SNAP-Ed direct educational

programminginyourcounty.

**Ifyoucompletedanannualpartnershipself-assessment,pleasesummarizetheresults[OPTIONALforFY16]:

**Ifyoucompletedkey-informantinterviews,focusgroups,rippleeffectmappingactivities,orother partnership/coalitionprocessorimpactanalysis,pleasedescribetheresultshere:

[OPTIONALforFY16]