Safe Routes to School Programs

The Governor’s Council Conquering Obesity Award

Programs – Recognizes exemplary programs that have been effective in helping individuals find success in conquering obesity through physical activity and healthy eating.

Note: For the written portion of this nomination form (located at the bottom), it's recommended that you type your response in a separate word document first and copy/paste your response into the text box area. This will prevent the loss of data should you need more time to fill out this form.

Your Information *First Name: *Last Name: *Address: *City: *State: *Zip:

*Phone Number: *Email: *Relationship to Organization:

Program Information *Program Name: *Address: *City: *State: *Zip: *County: *Contact Person: *Contact Person Phone: *Contact Person Email:

*Selection Criteria:

Each response limited to 500 words

Please provide a brief history of the program. Highlight the vision and/or goals of the program. (5 points)

Describe the steps the program takes to provide a safe and welcoming environment for participants. (5 points)
What strategies/tactics does the organization use to educate participants on healthy eating and physical activity? (5 points)
How does the program equip participants with the knowledge and tools to make choices for a healthy lifestyle? (5 points)
Describe any other classes or instructional activities the program uses to educate participants. (3 points)
If applicable, please list any other recognition or nomination the organization/event has received. (2 points)