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Tell us about a specific success your school/school district has achieved in their school environment(s). This success story may be related to asthma management, healthy eating, physical activity, sun safety, tobacco-free lifestyles, violence and injury prevention or another health topic.

Please complete this form for each separate success story and submit each separately. Do not combine several success stories into one submission. There is no limit to the number of success stories your school/school district can submit and we encourage you to submit as many success stories as you like.

Not all success stories may be published. The Success Story Administrative Team reserves the right to selectively publish success stories.

1a. Which of the following types of successes best describes the success story you are writing about? (Check the one category that best describes your success; if your success story falls into more than one category or is not listed, choose �other� and give a precise description)

	Asthma Management Success - such as adopting the State Board of Education Model Asthma Policy; providing school staff, students and families education about the seriousness of asthma; requiring that all students with asthma maintain a current asthma action plan on file; decreasing the number of environmental asthma triggers in the school environment such as furred and feathered animals in the classrooms.
	Healthy Eating Success - such as expanding or promoting school breakfast or offering healthier options at lunch, for a la carte items, in vending machines, at school stores or at concessions. Also includes such programs as farm to school initiatives (using local foods within the school), healthy eating special events, and policy changes (such as not using food as a reward or developing written policies to promote healthy eating).
	Nutrition Education Success - such as providing nutrition education curriculum, training, and resources. Includes providing nutrition messages that are in accordance with the USDA Food Pyramid. Also includes initiatives offering nutrition education family outreach events, and creating nutrition education policy changes.
	Physical Activity (PA)/Physical Education (PE) Success - such as longer or more recesses, more minutes of PE, recess before lunch, PA breaks in the classroom, PA programs before and after school, clubs or programs that promote PA, special PA events, enhanced PE curriculum, or purchasing new equipment to provide more PA options. Also includes policy changes like not using PA as punishment or establishing a written policy to promote PA or offer PE.
	Fuel Up to Play60 Implementation Success - such as student team building, kick off events, healthy eating and/or physical activity skits or activities, use of social media and student challenges. Includes the role of the program advisor and community outreach.
	Sun Safety Success - such as establishing a sun safety policy or offering education about sun safety.
	Tobacco-Free Success - such as developing a written policy for a tobacco-free environment, providing education about tobacco-free lifestyles, establishing a tobacco-free environment, or providing onsite or referral services for effective cessation.
	Violence and Injury Prevention Success - such as developing a crisis response plan; establishing policies for anti-bullying, positive behavioral support and safe schools; improving school climate; offering services related to violence and injury prevention; including violence and injury prevention in the health education curriculum; or offering programs for staff, families and communities related to violence and injury prevention.
	Organizational Success - such as establishing an active Coordinated School Health Team or other committee with representatives from key players in the school, district, and community or having health initiatives included in the school improvement plan.
	Parent Champions for Success - changes initiated by parents in any of the above categories (Asthma Management, Healthy Eating, Nutrition Education, Physical Activity, Physical Education, Sun Safety, Tobacco-Free environment, Violence and Injury Prevention or a key player in the schools' Coordinated School Health Team or Wellness Committee.)
	Staff Wellness Success - such as activities promoting the health and reducing health risk behaviors of school employees including obtaining administrative support, accessing community resources, conducting a needs assessment, convening a staff wellness committee, increasing awareness, implementing and evaluating activities.
	Social and Emotional Health Success - such as improving services and supports for students with mental health concerns and their families; establishing written policies for safe and supportive school environments; implementing programs and/or initiatives to promote safe, supportive learning environments; addressing student engagement and community involvement.
	Other, please describe:

1b. Please take a moment to further categorize your success. Select the one best option from the list below that describes your success story. If none fit, select other and provide your own category description.

Establishing/adopting model asthma policies

Education for staff, students and families about asthma

Maintaining current asthma action plans for students with asthma

Decreasing asthma triggers in the school environment

Other, please describe:

Healthier a la carte, vending or school meal choices

Not using food as a reward

Adequate time to eat

Healthier food offerings in school stores/concessions/school events

Sun safety playground/Field trips

Recess (longer, more, recess before lunch)

PA breaks in the classroom

Enhanced PE curriculum, more minutes/days of PE class, or other promotion of PE

Equipment/materials purchase to support health/healthier school environment

Healthier classroom parties/celebrations/school events

Classroom health education for nutrition, physical activity, tobacco-free lifestyles, sun safety, asthma management, and/or violence/injury prevention.

Establishment of an active parent committee or active parent representation on the Coordinated School Health Team (or similar committee) focused on improving the school health environment

Health promotion for staff

Parent role modeling

Other, please describe:

School breakfast

School lunch

Healthy snacks

New Look of School Milk

Healthier a la carte

Healthier vending

Healthy fundraising

Not using food as a reward

Healthier school stores/concessions

Healthy eating written policy

Local food initiatives such as Farm-to-School or school gardens

Healthy options offered at school/classroom parties, celebrations and events

Family and community involvement in support of healthy eating

Policies related to healthy eating/lifestyles promotion for school staff

Staff role modeling

Other, please describe:

Classroom nutrition/health education

Nutrition education through Farm-to-School or school gardening initiatives

Quality nutrition education curriculum used in classrooms

Quality nutrition education training and resources offered to teachers

Taste-testing, cooking/food demonstrations or other events related to healthy foods

Outreach events to educate students and their families and/or community members about healthy food choices at home

Nutrition education written policy

Programs/initiatives about making healthy food choices in all school venues (students and staff)

School health services/counselors providing education about healthy eating and lifestyles

Educational programs/events in support of healthy eating/lifestyles for staff

Other, please describe:

Sun safety written policy

Sun safety education

School health services directed toward sun safety

Family/community involvement in support of sun safety

Other, please describe:

Tobacco-free environment

Tobacco-free environment written policy

School counseling/psychological services directed toward smoking prevention/cessation

School health services directed toward smoking prevention/cessation

Family/community involvement in support of tobacco-free lifestyles

Programs/opportunities for staff for smoking cessation

School events that promote tobacco-free lifestyles

Other, please describe:

Longer or more recesses

Programs before/after school

Walking club/Pedometer program

PA breaks in the classroom

Fun physical activity included in classroom parties/celebrations

Not using PA as punishment

Recess before lunch

Physical activity written policy

More minutes of PE class

Promotion of PE

Enhanced PE Curriculum

Physical Education written policy

School counseling/psychological services directed toward more PA

School health services directed toward more PA

Family/community involvement in support of PA/PE

Programs/opportunities for staff for physical activity

Physical activity school events

Staff role modeling

Other, please describe:

Development/Implementation of a crisis response plan

Establishment of written policies on positive behavior support, anti bullying, safe schools, quality character education, standards for emergency use of seclusion and restraints

School climate improvements

Health education for violence and injury prevention topics

Program/opportunities for staff related to violence and injury prevention

School counseling/psychological services related to violence and injury prevention

School health services directed toward violence and injury prevention

Family and community involvement in support of violence and injury prevention

Other, please describe:

Student initiatives

Kick off

Healthy eating

Physical activity

Other, please describe:

Health Risk Assessments

Health education and behavior change programs

Staff wellness communication

Wellness incentives, employee motivation, and health promotion

Physical activity opportunities

Tobacco free lifestyles

Healthy eating

Social and emotional health

Other, please describe:

	Establishment of an Active Coordinated School Health Team or similar committee with representation from key school and community players and focused on improving the school health environment
	Inclusion of Healthy School Initiatives in School Improvement Plan
	Other, please describe:

	Building- or district-wide efforts to promote safe, supportive school environments
	Improving access to mental health services and supports
	Community involvement to promote safe, supportive schools
	Engaging students in activities and leadership opportunities
	Professional development for school personnel on social and emotional health
	Positive response to crisis
	Establishing written policies that support emotionally safe and supportive environments
	Other, please describe:

2. How long did it take to accomplish this success?

1 to 3 months

4 to 6 months

7 to 9 months

10 to 12 months

1 to 1 � years

1 � to 2 years

Greater than 2 years

2a. What month and year was your success story accomplished?

3. What was the nature of the costs associated with your success? (Check all that apply)

Materials/supplies
Release time/substitute costs
No cost
Other, please describe:

3a. Please indicate the approximate total cost:

$100 or less

$101 - $500

$501 - $1,000

$1,001 - $2,500

$2,501 - $5,000

$5,001 - $10,000

$10,001 - $20,000

Greater than $20,000

4. What factors were instrumental to your success? (Check all that apply)

	Coordinated School Health Teams
	Completing assessments (such as Healthy School Action Tool Assessment, School Health Index, Changing the Scene or Healthy School Report Card)
	Administrative support
	Other team/committee (other than a Coordinated School Health Teams)
	Funding
	Community collaboration
	Other, please describe:

5. Please provide a brief description of the success you achieved (2000 characters or less), including what made you decide to take these actions, the impact it has had on your school, and any other important aspects of the success and the process of achieving it.

Please be careful to ensure your submission is free of typos or other errors. You will not be able to change your Success Story after submitting it. The submit button is at the bottom of this form.

6. Who is actively involved on your Coordinated School Health Team or similar committee/team that helps promote healthy changes in your school/school district? (Check all that apply)

School Administration (Principal, Assistant Principal, Superintendent)
Nutrition Services (Food Service Director or Manager)
Physical Education (PE teacher)
Health Education (Health teacher, educator or school health coordinator)
Classroom teacher (not PE or Health)
Health Services Provider or School Nurse
School Counselor, Psychologist or Social Worker
Family Involvement (Parent/Guardian)
Maintenance and transportation staff
Local Health Department
Business
Local Government
Faith-based organizations
Student (on the team for middle/high school; input for elementary school)
Community Involvement (MSU Extension, Heart Association, Cancer Society, Asthma or Tobacco or Other Health Coalition, Law Enforcement Representative)
Other, please describe:

Our school does not have a team

6a. How many total times has this team formally met during the past 12 months?

0 times

1 time

2 to 3 times

4 or more times

If you've answered all the questions, you are ready to submit your success story. Please read and make sure you understand all the information below before you click the button to submit your success story.

By clicking the button below to submit your success story, you are consenting to have your school/school district information and story published on this and other related websites and in other print and web media used to assist other schools/districts working toward healthy school environments.
By submitting this form, you are providing permission for us to contact you for further information/clarification.
You will receive a confirmation page on this website when your success story is successfully submitted. You will also receive an email (to the email address you provided) confirming that your success story was submitted successfully.

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