Healthy HotSpot School District Application Form

District Information

School District Name: District #:

Address: City: Zip:

Applicant’s Name: Telephone: Applicant’s Email: Position:

Superintendent’s Name: Telephone: Superintendent’s Email:

Can the superintendent be reached during the summer through this contact info?

If not, please provide summer contact email and phone:

PE Director / Athletic Director Name: Telephone: PE Director / Athletic Director Email:

The district may nominate up to five schools to participate in the program. Schools may also nominate themselves:

School Name / Principal Name
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Please check all that apply below:

  1. Please indicate why schools in your district are interested in becoming a Healthy HotSpot through increased physical activity and enhanced Physical Education:

We recognize that healthy students learn better.

We want to gain knowledge and assistance to help compliance with the revised Illinois State Learning Standards on Physical Development and Health.

We would like to receive, at-no-cost, professional development and technical assistance opportunities for our staff around enhanced physical education implementing the revised Illinois Learning Standards and integrating fitness testing into P.E. curriculum.

  1. The districtis willing to participate in the process of completing:

Ahealth assessment and develop an action plan based on what is important and achievable in the school community.

A pre and post program evaluation of Healthy HotSpotInitiative.

  1. The district is dedicated to working towards adoption and implementation of the revised Illinois Enhanced PE State Learning Standards on Physical Development and Health
  1. There is a staff person(s) within the district who will be identified as the Wellness Liaison
  1. The district iswilling to dedicate district and/or school staff time to the Healthy HotSpot Initiative for professional development trainings and continuing education that supports implementation?

School staff representatives (P.E. teachers, administrator, Wellness Liaison) may attend a full-day professional development summit

Wellness liaison/staff representatives may attend a series ofprofessional development trainings over the course of two years to receive ongoing supplemental(virtual)technical assistance from the Alliance for a Healthier Generation.

PE teachers may participate in a training specifically designed for Physical Education Instructors. PE Instructors who participate will receive ongoing technical assistance from the Illinois Public Health Institute.

  1. If selected to receive support through the Healthy HotSpot Initiative the district is willing and able to:

Support participating schools in their efforts to create healthier environments through increased physical activity and enhanced PE.

Communicate with the Healthy HotSpotStaff and stay informed about schools’ progress

Work towards aligning school and district policies, procedures to meet the revisedIllinois State Learning Standards on Physical Development and Health.

Applications should be emailed to . Contact Erin Rasler 773-857-1276 for questions.